Report Process

Jon: Getting the pt. admitted. The biggest source of constipation in every ER. I am currently working in a small 8 bed rural free standing ER. We transfer EVERY pt. out. Each hosp. we trans. to has a different contol system. A 40 bed hosp leaves bed control up to the house sup. a 90 bed leaves initial control up to the house sup but if you call the right admitting doc a bed can magically appear. the trauma center level II let's the ER Docs admit. The other large hosp. 400 beds leaves bed control up to the admitting personnel. They check to see if there is a vacant bed. In our area of Nevada we are in a nursing crisis. There are three large hosp. One pays the most and has the least problem with recruiting. One isn't as desirerable to work at and the third (the trauma center) is in union negotiations and the nurses are leaving in hoards. The ER has 13 openings and more travelers then regular employees. We have major problems trans. pts. because there are no beds available (translation - NO NURSES to staff the units) When I worked at the trauma center, we started discharge planning on admit. Pt. had critical pathways started in the ER as well as all the normal paper work, orders, clothing list, secured items, etc. We also had to do some psych/soc hx. Too much time consuming paper work, esp. when you're under staff and the ambulances are bringing pts. in the back door.

I work in a 42 bed ED with an annual volume of approx 68,000/yr. Our admit volume is about 22%, with 1/2 of that going to critical care. Our ED docs do not have admitting priveleges, just usually write the orders. We currently phone report to inpt units. Have been trying to get agreement for fax report, so far unsuccessful. Bed control during "business hrs" is by an admissions coordinator (RN) who also controls transfers from other hospitals. After hours is by nsg supervisor. This usually runs smoother during high volume times, I suspect b/c the supvr. is out and about and it is more difficult to hide beds.

Community hospital 150 bed. Annual visits approx 19,000/yr. Non teaching. Bed control is done by house supervisor(RN) on off shifts and admitting office on days.
ER docs do not admit, they call attending and then write orders. We call the unit with report and take the pt to the unit. Giving report is always a hassle. Beds are never ready(so they say) or the nurse on the unit is too busy or unavailable for report. When beds are tight(happens alot) we hold pt in the ER until there is a bed available. There is never anyone around to help put the pt in bed. These problems between ER and other units seem to be on going and universal. Hope this helps!

Community hospital 150 bed. Annual visits approx 19,000/yr. Non teaching. Bed control is done by house supervisor(RN) on off shifts and admitting office on days.
ER docs do not admit, they call attending and then write orders. We call the unit with report and take the pt to the unit. Giving report is always a hassle. Beds are never ready(so they say) or the nurse on the unit is too busy or unavailable for report. When beds are tight(happens alot) we hold pt in the ER until there is a bed available. There is never anyone around to help put the pt in bed. These problems between ER and other units seem to be on going and universal. Hope this helps!

Sorry this came up twice, don't know why??