ER nurses not calling report anymore...

[plinytheRN]

Hey all, our hospital started a new policy where the ER nurses don't have to call report on the patients coming to our floor- they can choose if they want to call report. Most don't call report. It is up to us to find this patient and research all about them before they get to the floor, hopefully. Most of the time, they show up before we know they are coming. It is very frustrating and unsafe, we don't know anything about what we are walking into. I work on a medical telemetry unit, with usually 5-6 pts per nurse, it's hectic and busy no time to be clicking through a computer on a new admit. From what I understand this is a trial to test out this new policy, I am hoping it doesn't last. It seems the only one that benefits from this new policy are the ER nurses, it's definitely not ideal or safe for the patients... Anyone experienced this sort of thing? Thoughts? Thanks.

[schnookimz]

My old hospital did it this way. No called or written report. Nurses had to look up the info themselves and often didn't have time. Usually the information was looked up or gathered during the admission to the floor. It worked out fine.

[MunoRN, RN]

I was wondering about that, I will have to look into the laws about it. I am in Louisiana. They even sent one patient up with any IV access! I am starting to wonder what they do down there!

The Louisiana BON description is a bit vague:

http://www.lsbn.state.la.us/Portals/1/Documents/Examiners/ExaminerNo22013.pdf

(Page 4)

Though it does seem to refer to reporting off as a requirement when transferring care. If you're at a Joint Commission accredited facility then it's certainly more clear; this would be a violation of their safe handoff requirements under their communication standards.

[weirdscience]

Can you call down to the ED and ask for a report? Someone has to be able to tell you who the pt was assigned to in the ED. This policy seems dangerous and unsafe.

[Altra, BSN, RN]

The Louisiana BON description is a bit vague:

http://www.lsbn.state.la.us/Portals/1/Documents/Examiners/ExaminerNo22013.pdf

(Page 4)

Though it does seem to refer to reporting off as a requirement when transferring care. If you're at a Joint Commission accredited facility then it's certainly more clear; this would be a violation of their safe handoff requirements under their communication standards.

Not so. I've worked in a hospital where report on a non-ICU patient consisted of just the electronic documentation from the ED -- no Joint Commission problems.

[MunoRN, RN]

Not so. I've worked in a hospital where report on a non-ICU patient consisted of just the electronic documentation from the ED -- no Joint Commission problems.

The Joint Commission's NPSG on handoff communication requires an interactive report. This applies to all inpatient handoffs with inpatient mental health being the one exception.

AHRQ Patient Safety Network - Handoffs and Signouts

[NICUmiiki, DNP, NP]

I know at my hospital, the nurses can send an SBAR sheet in lieu of calling report, but I haven't seen it happen yet. It seems like everyone prefers to call. I have seen a nurse threaten to use it if the floor nurse didn't call back for report within a certain amount of time, but she/he did call and all was well. The ER charge nurse will call the flor charge nurse if the floor nurse doesn't take report in a timely manner.

My hospital is also a JC Top Performer.

[Altra, BSN, RN]

The Joint Commission's NPSG on handoff communication requires an interactive report. This applies to all inpatient handoffs with inpatient mental health being the one exception.

AHRQ Patient Safety Network - Handoffs and Signouts

The hospital went through a JCAHO site visit while I worked there - no citations regarding handoff.

[Altra, BSN, RN]

I know at my hospital, the nurses can send an SBAR sheet in lieu of calling report, but I haven't seen it happen yet. I have seen a nurse threaten to use it if the floor nurse didn't call back for report within a certain amount of time, but she/he did call and all was well.

It's probably not a "threat" ... but a procedure defined by policy.

[NICUmiiki, DNP, NP]

It's probably not a "threat" ... but a procedure defined by policy.

It still comes off as a threat since its not normal to send a patient up without calling, and the receiving nurse wouldn't like getting the patient without report.

[MunoRN, RN]

The hospital went through a JCAHO site visit while I worked there - no citations regarding handoff.

The Joint Commission is not a regulatory agency and does not issue "citations". You don't have to meet all of their requirements to "pass". And if you worked there before 2006 it was not a NPSG prior to that.

Besides being a JC and often a BON requirement, we no that most of the harm we cause to patients comes from communication failures, much of those coming at handoff. There are few things we can do protect patients more important than maintaining basic good communication standards. Even a bad handoff is better than no handoff.

[NurseKatie08, MSN]

When I first started at my current hospital, the ER used to fax report (and would call to make sure we got it) I HATED this. Now they call and give report using an SBAR format, but we are not allowed not to answer. If the primary nurse is unable to come to the phone at the time they call, the charge nurse has to take report on the patient. This system is better, but I'm still not the biggest fan. I prefer to take my own report whenever possible.

[Altra, BSN, RN]

JC is a de facto regulatory agency, as accreditation is required for Medicare/Medicaid reimbursement as per CMS.

I'm just relaying information to readers that nonverbal reports have not incurred citations from JCAHO, nor our state DOH. I'm using the general term "citations" to broadly include all negatively noted variances from standards. And I'm referring to post-2006 practices where I have worked.