Monday - Sunday, 8am to 8pm
ED 4:  34,35,36,37,38,39,40,41
ED 31/Procedure/Discharge Room will be left open and used for slit lamp exams and ENT procedures as needed, consults and discharge patients home as needed.
Staffing: two NPs, two RNs, one NA
Responsible for ESI level 4 and 5 patients
Responsible for overall turnover of rooms by discharging patients and bringing in new patients to be seen
NP and RN will pair up and take 4 rooms each, 34-37 and 38-41
RME Unit rooms will be set up with gurney against the wall and a chair in center of room in which patients will be placed.
Patients who remain in the ED 4 from the nightshift will either be discharged or moved to another area as soon as is possible for nursing staff.    Night shift staff will attempt to move these patients at 6am.   Dayshift stay will continue moving patients held over from the night shift.
In the morning when ED 4/RME Unit rooms are empty, Triage RN will place ESI level 4 or 5 patients directly into empty ED 4/RME Unit rooms; when these rooms are finally full, the responsibility for room turnover will shift to the staff in the RME Unit.
In the morning, when ED 4/RME Unit beds have been filled by the Triage RN, additional ESI 4 and 5 patients can continue to be placed into other ED beds in ED 1,2,3 or 5 if ESI 1-3 patients do not take precedent.
NP provider will sign up for the patient in the Res/ML column
RN will not sign up for the patient on the Tracking Board.   The RN, however, will be responsible for patients who are under the care of the NP with which they are paired.
RN is not required to complete an assessment on every RME Unit patient.   If medications given, etc, then a reassessment should be completed.    If RME Unit patients are on the track more than 4 hours, a reassessment must be done by the RME Unit RN in the waiting room.
RME Unit Nursing (RN/NA) responsibilities:  visual acuities, drawing blood, obtaining urine samples, sending patients needing plain films to PWR, calling Radiology about patients need utz or CT scan, anticipating procedures such as lac repairs or gyn exams and moving carts to the room, moving patients to and retrieving patients from the waiting room, etc.
Any patient placed in RME Unit who is subsequently deemed too complicated for RME Unit will have an RME documented, their ESI level changed to 3, orders placed as needed, and patient moved either back to the waiting room or when possible to ED 1, 2, 3, or 5.  Responsibility for these patients should also move to the ED provider and nursing staff in those areas.   If moved back to the waiting room, responsibility falls back to the Triage and Reassessment RNs.
Patients requiring plain films will be sent down to PWR/Radiology WR to wait for their imaging.  RN or Provider will change the bed assignment to PWR.   Radiology tech will then look on the tracking board, find the patient in PWR, complete the plain film imaging and then tell the patient to return to the RME Unit/ED 4 Nursing Station.   The RME Unit RNs will then change the bed assignment to TR4 and send patient to waiting room to wait for imaging results.
ONLY RME Unit patients requiring plain films will be sent to PWR/Radiology WR.
Patients who are waiting for laboratory testing results, imaging such as utz or CT, plain film imaging results, or consultations by subspecialits can be moved to the waiting room.   Bed assignment will be changed to TR4 in order to keep them visually separate from the other waiting room patients.  These patients will remain the responsibility of their providers while they are in the WR awaiting results.
Patients moved to the waiting room (TR4) or ED 31/Procedure/Discharge Room will not be counted toward the nurse/patient ratios because they will need limited nursing interventions.
Patients who need to receive discharge instructions will be discharged in their ED room assigned or in ED 31/Procedure/Discharge Room.
RN will notify housekeeping when a room needs to be cleaned; RN will choose a new ESI level 4 or 5 patient from the WR to fill the room.
At 7pm the night shift RNs assigned to RME Unit will assume care for the day shift RN’s patients and continue working with the NP per the above guidelines.
At 8pm, the RME Unit will close, and patients who are still in progress of being cared for by the RME Unit team will be signed out by the day shift NPs to one of the night shift residents.  The night shift RNs assigned to EDs 4 continue to care for the patient until discharge.
At 8pm, ED 4 will be used along with ED 1,2,3 and 5 beds for a variety of patients. Triage RN will be responsible for assigning patients to those beds.
If the RME Unit is successful, we may extend hours to 8pm-8am when a night shift Nurse Practitioner has been hired.    We may also extend the RME Unit, as needed, to include additional ED beds and other ED nursing and provider staff.
ONLY RME Unit patients requiring plain films will be sent to PWR/Radiology WR.
OVMC:ED
RRMC:ED
SCVMC:ED
SCVMC:EXC
SCVMC:Main
MHH-TMC
Tdap
Harbor Macros: AMA