The emergency department is hopping, and David Cummings is doing his best to keep his trademark positive attitude. As a nursing coordinator, he’s charged with finding available, medically appropriate beds for the 40 or so patients admitted through the ED each day.

Cummings also supports his department’s goal of efficiently triaging patients by expediting wherever possible, whether that’s locating residents to evaluate patients, checking on a CAT scan or wheeling a patient to a floor. “I’m like the center fielder for safety,” he explains. “I can’t just get patients out of the ED; I need to get them the best care as quickly as possible.”

But because only 20 percent of the hospital’s admissions come from the ED, Cummings must compete for beds with walk-ins from Admitting, Hopkins Access Line referrals and even nursing coordinators in other departments, such as David Harriman.

Harriman, a nursing coordinator for Medicine, is not only on the receiving end of Cummings’ ED patients, but also those coming from the Outpatient Center, intensive care units, the Cardiovascular Imaging Laboratory and Endoscopy, plus transfers from other departments.

Through frequent contact with charge nurses and a computer-based patient assignment system nicknamed MedBed, Harriman keeps tabs on what beds are opening across nine units, including the medical intensive care unit. “You’re constantly re-prioritizing, balancing departmental resources and the care requirements of the patients,” he says. “Is that bed or floor appropriate? Does filling that bed meet the department’s needs? And who comes first: the patient sitting in Admitting, the patient from the clinic that’s closing in ten minutes or the patient who’s been waiting in the ED for six hours?”

Medicine always has two nursing coordinators on duty; one is assigned to the code team. There are also coordinators in the departments of Surgery, Neurology and Oncology. Along with Mary Margaret Jacobs, director of admitting and patient/visitor services, and Robin Lewis-Cherry, assistant director of admitting, they “meet” at 2 p.m. each day for a conference call to audit that day’s bed situation and find ways to help each other.

With such a broad view of the hospital, nursing coordinators also serve as a knowledgeable resource for staff nurses with questions ranging from policy to patient safety. They facilitate patient movement and manage expectations on all sides. And, as in Cummings’ and Harriman’s case, they must work well together even under extreme pressure—both patients and colleagues depend on it.

-From Hopkins Nurse, Spring 2006

PHOTO: Nursing coordinators David Harriman, left, Medicine, and David Cummings, Emergency, are on the front lines of the daily tug-of-war over beds.