ER handoff report to floor - page 4

by PatricksRNMommy 19,285 Views | 47 Comments

In the past when receiving patients from the ER, they printed a report to the floor and then called to give a verbal report. Now the process has changed to improve pt flow. Now, the report is printed to the floor, the ER nurse... Read More


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    Haha.... since I first posted in this thread last year, I've switched ERs (and states, for that matter!), and now it's like being back to square one ... waiting for someone to be available for verbal report. I miss my VoiceCare! But I have to say the floor nurses are pretty good at my hospital. The only snag I've run into was taking a chest pain patient up to the ICU, and the ICU nurse not being able to get the ICU bed out of Trendelenburg. She got flustered, the patient whispered to me, "Can I come back downstairs with you?" Tee hee!

    thelema13, sorry you had a hard day. At the end of my hard days, there is sometimes a Guinness or three and a feeling of gratitude that I am an ER nurse ... because I'd hate to be anywhere else! Seriously.
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    Quote from thelema13
    I am an ER nurse, and I understand the floor is busy sometimes, but when I have to phone up 4 different times to get my nurse to give report, I am pis***. Now, I will phone once and give the benefit of the doubt that the nurse is busy. The second time I phone and the nurse is not available, I will ask to speak to the charge nurse. Sorry, but we get slammed all the time with unexpected patients. I have up to 8 at one time, the nurses on the floor have a max of 4. Come on, do your job. Sorry if this is a rant, but a hard day and a few beers and I don't care.
    A max of 4? I wanna work there! That being said, I've had 4 that felt like 8...numbers alone don't indicate acquity.
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    My personal thoughts:

    * At my facility, the protocol is to call for report. If nurse is unavailable to take report, wait 10-20 minutes and call again. If nurse is still unavailable to take report, fax the chart to the floor and take the pt. up. The only floor where this is unacceptable is the ICU where there MUST be a verbal/face-to-face report before pt. transport.
    * Beds are not given to ED unless they are clean and a nurse has been assigned to that bed upstairs.

    That being said:
    + Unless I'm balls-to-the-walls slammed with pts. and my waiting room is overflowing; I give the floors the benefit of the doubt. If a nurse tells me 'to call back in ten minutes', I'll give 'em fifteen and I'll call back. I know what it's like to work on a post-op floor with 6 patients (5 of 'em who are fresh post-ops) and then being told you'd be getting two ER admits...
    + But if I AM getting absolutely slammed with pts., I make a polite but firm request - someone needs to take report NOW or I'm faxing the chart and sending the patient up. I don't really have a choice in the matter - I'm not doing it because I'm bored, I'm doing it because I need the bed! (one of my charge nurses actually calls report on pts. if she feels I'm "slacking off".)
    What bothers me sometimes with all this is - how come floor charge nurses don't take report if the assigned nurse is truly busy with patient care?
    + I've also observed floor staff take off clean sheets on a clean bed and then make the claim "bed is not clean" or "housekeeping has been paged to clean the bed". Or I'll be told "the bed is not cleaned" or "there is no nurse assigned to that bed yet".
    + I've also observed many of my colleagues with the "that's not my problem" attitude. While it's valid in many cases (because there are more pressing problems to address), sometimes I think it's taken a bit too far.
    + I can't (and I don't) send pts. up without completing now/STAT orders.
    + If I think a pt. bed assignment is in-appropriate (i.e. this pt. needs to go to tele and not med surg ... or this pt. doesn't need tele they can go to med-surg), I call the doc. But I'm not the final arbiter of where the doc sends the pt.
    + One BIG stumbling block I've come across in terms of getting beds is housekeeping. Apparently there aren't enough housekeepers on the 3p-11p or 7p-11p part of the shift. Which means beds are open and not clean, delaying pt. flow.


    cheers,
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    Just started in a new ER (one of the largest in the state) and our CEO is all about ER flow. In my part of the ER it is 2:1 and we have a 3 hour window from bed to out. Our hospital has set the policy that unless the patient is going to a unit, no report is to be given. Once admit orders are received, our secretary sends it out to placement and once a bed is received from placement, we call for transport. Once transport arrives, we call the floor's charge and let them know that their ER patient for bed XYZ is on the way and to have a nice day. A copy of the ER chart goes with the patient and that is that. Once a bed is received from placement, we have 15 minutes to have them out of the ER.

    It was weird getting used to this but it makes sense. Its a busy and very large hospital (800+ beds). Getting a hold of the nurse isn't always feasible and even after getting a report from the ER, they get a full story from the patient anyway. If the patient isn't able to give the nurse upstairs any info, they're typically going to be going to a unit which will get a report from us. And if any questions do arise, the floor nurse is more than welcome to call us with any questions they have. I don't know how well this is going for the floor nurses since I'm still quite new here, but for the ER it is very smooth.
    Altra and GM2RN like this.
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    Quote from Roy Fokker
    One BIG stumbling block I've come across in terms of getting beds is housekeeping. Apparently there aren't enough housekeepers on the 3p-11p or 7p-11p part of the shift. Which means beds are open and not clean, delaying pt. flow.
    Story of my life there. I have witnessed a SIX HOUR WAIT in the time of a bed being called into the environmental services system and the bed being clean and available. If the bed is posted, we can change it to a "STAT clean" but that sometimes amounts to a hill of beans.

    I feel bad about it when I know a patient is sitting on a stretcher in the ED and should be in a bed upstairs, and there's a patient in the waiting room or hall who should be in the ER stretcher.
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    Thank you VICEDRN! I give report the same way, by fax but still the units expect a verbal. I do not have the time to give verbals unless its ICU in which case I will. Why can't the floor nurses read a report? I got through nursing school reading my textbooks, that does not stop because you are a nurse now, read the report and get prepared, I did at the last place I worked, I had mabye 5 minutes before the admit hit the floor, and I dealt with it!!!
    It's a hospital, with an emergency department, so you will get admissions! Need I say more?
  7. 0
    I'm sorry to "hijack" the thread, but I cannot PM yet and I would like to ask you a couple of questions about Sebastian hospital. Can you email me at shir977@gmail.com? I am originally from Vero and am ready to come home :-)

    Thank You,

    Heather
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    I believe that all reports should be verbal no matter what unit. It allows the nurse to be prepared as well as gives the nurse who is actually taking care of the patient or admitting nurse the opportunity to ask questions. In addition to using this method, the receiving nurse has the opportunity to decide if he/she is willing to accept and resume care of the patient. There have been times when verbal reports have protected the patient from arriving to an inappropriate unit bc the nurse on the receiving unit knows what resources are available in regards to med supplies/equipment, monitoring, and staffing. Al7139, seeing as though we all got through nursing school by reading, you should know d*%#! well that reading report is not the issue for floor nurses. What does stop after becoming a nurse is the ability to NOT take full responsibility should an issue arise regarding an unsafe assignment after taking report. In the progression of being student to nurse, we should advance from just reading to being critical thinkers. Let's be treated like professionals.
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    We started faxing reports a couple years ago. Phone reports take way too long. We still call report from the ICU to the floor. For me, I don't care what size the IV is. All I need to know is if he's got an IV. I hate it when you are interrupted with "wait, so the IV in the right arm is a 20G and the left arm is an 18G. Is the IV in the left arm in the AC or is it in the forearm?" It doesn't matter. Look at the pt when they get there. If a pt had back surgery 10 years ago, don't ask me who did it. It doesn't matter. If it's that important, look it up. Report ends up being 15 minutes long for a stable, routine admission.

    There is no official way for calling report. Everyone is different. Some jump around, some follow the same routine. All I can say is don't interrupt me. If you have something quick here or there to ask, that's fine, but if I am talking about the neuro status, stop asking about the foley and or if they have accuchecks at that very moment. What meds do I have to give 4 hrs from now? Really...look at the MAR. (yes, happens all the time). Let me finish report and you can ask questions at the end if you need. If you can't remember what you wanted to ask at the end, it probably wasn't important in the first place.

    I know the floors are busy. Everyone is busy. I think the more a person can write down during report, the less nurses actually have to read in the chart. If a very detailed report is given, that piece of paper is then used to give report at the end of shift. And I think that is lazy. My point is, when I get report, tell me the important stuff. I don't care about the IV size, or accuchecks, or what size the foley is...I am going to read the EMR anyway and get everything and more from the chart in order to give the best care. I hate getting asked what doctors are on the case. Read the chart. I'll tell you cardio is on case, but if want to interrupt me to ask what the name is, look it up.

    Then there's nurses who have the need to tell you their own personal experiences with some disease process. This guy was on coumadin and he fell..."Oh yeah, you know my mother was on coumadin and she had a lot issues with it. One time we..." Wait, wait...that's great. Let's move on with report. I thought things were busy....

    And the last thing that is frustrating with phone report is the nurse who has to write everything verbatim. This guy was admitted for intracranial hemorrhage. He is allergic to PCN. "Hold on, hold on..allergic...to...PCN. Intra...cran.....can you spell that for me?"

    Faxing report is quicker and all the important info is on there. If there is something specific you need, look it up. If a nurse brings up a crashing pt or things are not done, then yes, there are things that should have been done before transfer. If someone has a low Hbg, then, yes, blood should at least be started. But so much time is wasted on useless nursing information. And at the end, we still have to transfer the pt, which always ends with nurses magically disappearing when the pt comes out of the elevator. I end up yanking the call light out of the wall so that light continuously goes off until someone shows up. Face to face is never gonna happen. Because that would mean I can just unplug the wires, immediately bring them up, and have the nurse waiting for me in to room for report. Yeah, that's never gonna happen.
    Altra likes this.
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    At my hospital, the ER nurse calls gives the floor nurse report via phone. There are no printed report sheets. The floor nurse should have the computer in front of them with the patient's chart opened so that they can clarify anything from the ER nurse's report. Usually our patients are stable enough to be transferred to the floor.


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