Inappropriate ICU Transfer of the Week

When folks need to go to the Unit, whether it is an evolving MI, (non)lethal arrhythmia, hemodynamic instability or they just need that higher level of care, we can’t wait to get them off the floor. Last thing anyone on our floor wants is a truly unstable patient lingering in one of our rooms when they needed to be the Unit 20 minutes ago. Sometimes though, you just can’t seem to convince the docs that they need to go and in the same vein, those that really don’t need to go, get sent.

We had a couple of instances of that lately. First, we called a Code on a guy who vagaled on the toilet. He was down to the Unit in less than 15 minutes, albeit already awake and laughing with the transport nurses as he went. At the decision time though, he needed to go. Now.

On the other hand is the patient who is stable but the docs are convinced they require  the advanced monitoring care of the ICU. This happened just the other night.

Let me remind you, we’re a cardiac unit. We deal with post-PCI patients, pacers, rule out MI’s, pre/post-op open hearts, CHFers, arrhythmias (like atrial fibrillation with rapid ventricular response) among other things – like being the largest unit in the hospital and getting overflow patients. When it comes to all things cardiac, we’re the place to be. Guess that’s why the sign over the entrance to our unit says “Cardiology/Cardiac Surgery”.

Anyway. My colleague’s patient was post-chole or some other laproscopic surgery. Nothing too hot and heavy. She goes in to asses her patient (who’s not on tele) and notices her heart rate is rapid and irregular. Being the good cardiac nurse she is, she grabs a12-lead EKG and voila’ – a-fib with RVR. She calls the surgical resident on call who orders some metoprolol to slow down the rate and eventually a diltiazem drip. No biggie to us. We do this all the time. Heck, with our fresh hearts we have an A-Fib protocol where we don’t even have to call the surgeon if the patient goes into fib, as long as they’re hemodynamically stable. We just follow the protocol.

In this case, after the drip was started, blood pressures were 110’s over 70’s, rate in the 80-90’s, good perfusion (warm, pink and intact), making urine, not even short of breath. Totally manageable on our floor. But the surgical resident still wants to transfer. My colleague tries to suggest that it isn’t needed. She did everything but come out and say, “Y’know what? She’s stable. Her rate’s good. She doesn’t need to go.” Not that it would have done any good. So off she goes at 0630 down to the Unit. Her rate on arrival to the unit was 70’s and it looked like her heart was already trying to convert back into normal sinus.

I looked at the ICU nurse and said, “Ten bucks says she’s back up by the end of the day.”

To which she replied, “End of the day? She’ll be back up by noon!”

“Right,” I retort, “if they haven’t given her room away…”

It’s a Murphy’s Law kind of thing: they go when they don’t need to and stay when they do.

And for all you soda drinkers out there, here’s a little bit of science to enliven your day: “What happens to your body if you drink a Coke right now?” Now, off to the fridge, I’m kind of thirsty…



  1. Thanks for the perspective. For my daughter, we have so much equipment already at home (ventilator, O2, etc.), we’re always arguing to just go home.

    Loved the Coke blog BTW. Explains my old, 6-a-day habit. Now I’ll just go finish that pot of coffee off….


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