Hello,

I am researching various methods of improving and expediting the transfer of patients from the Emergency Department to Med/Surg. My question is does anybody's facility use a patient handoff system that does not involve direct initial contact between the ED nurse and the MS nurse BEFORE the admitted patient is transfered into his/her room. For example: In my facility once the patient is admiited to the floor and a room assignment is made the ED nurse makes a call to the MS nurse or Clinical Coordinator on MS and gives report, then the patient is transfered upstairs by a patient care tech or transporter and placed in room at which point the MS nurse assumes responsibility. This is the way its been done is most facilities for many years - however it does have limitations such as you require two of the busiest nurses in the hospital (ER nurses and MS nurses) to physically come to phone and give/take report before the patient is transported. This often causes delay in moving the patient - which results in numerous undesirable consequences not the least of which is patient satisfaction etc. If your facility does something different would you be so kind as to reply here and decribe your process.

Thanks

Kevin

Yes, my facility does this. In some respects, I prefer just looking up the information in the EMR rather than listening to some BS report from an ED nurse who maybe has had the patient for an hour. At the same time, I don't like it because I think it takes some responsibility off the ED and they can pretty much send up whatever, whenever. On the whole, I'd prefer to still get some kind of phone report if for no other reason than I don't like the precedent the non-direct system sets.

My state's DOH/BON does not allow patients to be transferred without a verbal report occurring prior to transfer. Another facility learned this the hard way when they switched to a faxed report (ER Nurse fills out a report form, faxes that to the receiving unit, then 15 minutes later transfers the patient), they were hit with violations and fines for multiple instances of patient abandonment because, as it turns out, the DOH considers any patient transfer where a verbal report with the opportunity to ask and answer questions does not occur to be patient abandonment. Your state's DOH may not take such a hard line on this but it's worth looking into.

The best way we've found to speed up this process is to put hard limits on it: The ED Nurse will call to give report 30 minutes after the bed request is placed, if the Nurse is not available at that time then the ED Nurse will call back in 15 minutes and give report to the NTL. These are pretty aggressive time goals however, we looked at the "average" ED transfer delay time, which average more than 2 hours, so if you can do it in about an hour for the most part you're way ahead of the curve.

The most helpful thing we've found is to make ED-to-floor reports less of an obstacle by making it less burdensome. Many Nurses expect information in the report that isn't necessary; there's no need to go through all the information that is available to both Nurses, it should just be an opportunity to have a (short) discussion about the outliers and plan, (no more asking "where is there IV"- it's the brightly colored thing taped to their arm). This alleviates the problem where both the ER and MS Nurse feel like they need to free 10 minutes for report, 3 should be plenty.

In my hospital, I (floor nurse) receive the name of my admit from my charge. From there, I pull the patient up in the system, review notes, etc. the ED nurse then (should) call me and ask if I have any questions prior to transfer. I honestly don't like it, a lot of things are missed because the ED has a different charting system and not all things transfer over, and while notes, the H&P, and HOPI are good information, it does not give you a full picture of whats going on.

This is pretty much how it works at my facility - minus the part where the ED nurse phones the floor nurse. The best we get is a phone call giving a heads up that they are bringing the patient up. They didn't always do that until they got too many complaints that the transport was dumping the patient in the room without telling anyone.

In my hospital, I (floor nurse) receive the name of my admit from my charge. From there, I pull the patient up in the system, review notes, etc. the ED nurse then (should) call me and ask if I have any questions prior to transfer. I honestly don't like it, a lot of things are missed because the ED has a different charting system and not all things transfer over, and while notes, the H&P, and HOPI are good information, it does not give you a full picture of whats going on.

We tried to go to simply a EMR report, but it got to the point where the ED was sending patients up when we had not had a chance to even look over the patient information. Sometimes the floor is simply NUTS and it takes a minute. :) Right now, we get paged the patient - the new nurse will get the name and information, look up information in the EMR, and then the ED will call and verify that the receiving nurse has had a chance to look over the patient information and make sure they have no questions and are ready for the patient.

I really think (even though it does take some time!) that it is important to get that verbal "ok" from the receiving nurse before sending a patient to the floor. In the trial phase of our "no contact" handoff, we had several patients brought to the floor where the room wasn't ready (there was a bed instead of a needed crib, or there wasn't a bed at all) and that just makes the entire hospital look sloppy.

This is an ongoing issue in my facility. The floors get pt that should be in a higher level of care from the start. I have been to rapids because the pt was in A Fib with RVR as soon as they hit the tele unit and the pt needed transfer to ICU to manage HR. The ER charting system is all over the place. You don't get a full picture of what is going on with the pt at all sometimes. Sometimes they don't even call to say the pt is on the way up and transport brings them up. It is a mess. I prefer verbal report such as the ICU gets, but we were told by our CNO that we aren't going back to that. Hopefully with EPIC it will be easier.

This process is frustrating.

I find that method of report kind of dangerous.

A transporter takes the patient to the floor with no nurse escort?

Report is done on the phone without the receiving nurse being able to visualize the patient? (The faxing report story was even worse!)

What if transport leaves the patient in the new room and the receiving nurse is so busy they don't get to see them for ages?

The best place I worked performed bedside handover in an SBAR format from ER to the floor. The nurse would hand over with the receiving nurse in the room. That way the patient saw their new nurse and saw that everyone was on the same page with what was going on. This way the receiving nurse could ask questions and the ER nurse could show the floor nurse any wounds/dressings/IV sites etc etc.

Phone report just doesn't seem like safest practice even if it is more time efficient.

Thank You very much for your input. This issues / experiences you bring up seem to be common across most facilities. The everyday routine handoff communication typically done by phone is more than just a report of the patients condition it is an official notification of the handoff of responsibility for the patient. Therefore it seems any system or protocol must involve a verbal notification that the patient is both in and oriented to room and that the sending nurse is available if floor nurse has any questions. With that understood does that notification have to come from a nurse? - Could the coordination of the patient travel post admit orders be run by some other traffic cop? I really like and agree that with our EMR's and digital orders the 10 minute report is excessive and quite a waste of time. It is a difficult problem to solve. Thank you again for your inputs I wish all of you the best.

Kevin