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.

[shoegalRN, RN]

Also, as a floor nurse, I started IV's when I was on the floor. Most times the patients would come up from the ED with one IV and if I needed a second IV I just got the order from the doctor and started it myself. As an ER nurse now, I don't get why the floor nurses can't start IV's. Not every Med-Surg patient requires an IV. I don't know how many times we get called in the ED to come up to start and IV on a patient and you can see their veins from the door without an tourniquet.

[lub dub]

Don't think so sweetie. Sprained ankles and rashes go through express/urgent care and don't get admitted. My guess the problem with the report is that the receiver isn't available, the patient is held and that stops that patient throughput. Meanwhile triage is bursting at the seems and the ambulances keep rolling in. Sounds like you have some insecurity issues with your job.

No insecurity issues here. I've just seen more than my share of lazy and/or inconsiderate ED nurses who will do whatever it takes to empty their rooms by the end of their shift.

[Altra, BSN, RN]

No insecurity issues here. I've just seen more than my share of lazy and/or inconsiderate ED nurses who will do whatever it takes to empty their rooms by the end of their shift.

I'm sorry, but this comment has no basis in reality. You say "empty a room" like it's some kind of completed task that has some benefit for the nurse. There will be another patient in that room within 10 minutes, possibly as little as 30 seconds after being "emptied". "Clearing your rooms" -- by coincidence discharging and/or sending all your patients who are admitted on their way within a short period of time happens sometimes, but guarantees 4-5 new patients within the next hour. Yes, read that again -- 4-5 new patients about whom you know nothing -- within an hour. And you still want to ***** about having an insufficient amount of time to digest this one patient that is being admitted to your unit.

Throughout this thread we've discussed the hospital-wide significance of throughput, and the reality that patients are waiting for ED beds both in the waiting room and out there in ambulances. But I'm not reading much concern about *patient care* for those patients -- just the one who you're getting.

[lub dub]

I'm sorry, but this comment has no basis in reality. You say "empty a room" like it's some kind of completed task that has some benefit for the nurse. There will be another patient in that room within 10 minutes, possibly as little as 30 seconds after being "emptied". "Clearing your rooms" -- by coincidence discharging and/or sending all your patients who are admitted on their way within a short period of time happens sometimes, but guarantees 4-5 new patients within the next hour. Yes, read that again -- 4-5 new patients about whom you know nothing -- within an hour. And you still want to ***** about having an insufficient amount of time to digest this one patient that is being admitted to your unit.

Throughout this thread we've discussed the hospital-wide significance of throughput, and the reality that patients are waiting for ED beds both in the waiting room and out there in ambulances. But I'm not reading much concern about *patient care* for those patients -- just the one who you're getting.

Altra, your post has no basis in reality. I have seen data from the telemetry floor of a hospital that shows consistently a cluster of admissions from the ED from 6 am - 7 am and from 6 pm - 7 pm. And this is not just one day. It is many many days. A "coincidence"? I don't think so.

[Altra, BSN, RN]

Altra, your post has no basis in reality. I have seen data from the telemetry floor of a hospital that shows consistently a cluster of admissions from the ED from 6 am - 7 am and from 6 pm - 7 pm. And this is not just one day. It is many many days. A "coincidence"? I don't think so.

Have you considered the role of bed control at your hospital? Apparently not.

[Esme12, ASN, BSN, RN]

It is ok to disagree without being disagreeable.

I wish hospitals would allow more cross training. Make each other walk in each others shoes. It is always much clearer when you are on their side of the fence.

LubDub....

I have seen data from the telemetry floor of a hospital that shows consistently a cluster of admissions from the ED from 6 am - 7 am and from 6 pm - 7 pm. And this is not just one day. It is many many days. A "coincidence"? I don't think so.

This is probably ntrue. what I would find interesting is what are the MD's shift in that department. Much of the time...the ED nurses have little to NO! influence on when the patient is admitted. We are ready FAR before the MD is.....there at those MD's that drag their feet all day and then realize it is the end of their shift......they panic because their relief...their peer will be very upset at having to do another H&P on this patient waiting for dispo....so they get all the patient admitted....then we get the supervisor/administration/manger yapping at our heels because "we" took too long to admit the patient ...like we had participation in the process.

LubDub.....I think making a sweeping statement

I've just seen more than my share of lazy and/or inconsiderate ED nurses who will do whatever it takes to empty their rooms by the end of their shift.

is unfair because the opposite can be said that the ED has seen their fair share of inconsiderate, lazy floor nurses and that gets us no where. we need to work together to find a solution instead of blaming each other.

There are many factors that influence the flow of the ED and the admission times of patients. If there is an unacceptable pattern then that needs to be looked at and solutions found. I developed several solutions to get the D MD to act sooner by stopping admissions to the floor during shift change 6-8 PM suddenly patient were able to be moved before of after those times. YOu also need to look at the trends of Day surgeries to go home or to be admitted when that occurs and all the ebb and flow of each individual department.

It looks much different when you look at the process as a whole. But I believe we can be kinder to each other when we try to discuss these situations.

[CodeteamB]

At my hospital we enter report in the computer charting system. We have a form that self populates most information (allergies, labs, inpatient orders, diagnosis etc) we fill in things like focused assessment, VS in last hour, communication needs, other charts to review. We then call the floor who already know the patient is coming. All that is required is that we confirm with the receiving nurse/charge that the room is clean and they are not actively coding someone else and then the patient is on their way, report can be read at their convenience.

ICU, CCU and OR get verbal face to face report.

We have 15 minutes from bed allocation to get the patient out if the ER, there is no messing around, if I have orders, then I don't have time to sit on hold and then answer a million questions about the consistency of bowel movements and where the IV is.

ED nurses not giving report on patients seems inexcusable to me. I'm so tired of ED nurses who think that they're too busy saving lives to do small tasks, like phoning report, when the truth is that unless you work in a big city trauma center, you're dealing with sprained ankles and rashes a majority of the time. So pick up the phone & give report!

"We're sending you Billy Bob. As noted on the chart, he's here for abd pain. His allergies and home meds are documented as required, his IV can be found at the end of the tube running from the NS bag, all the meds we gave are documented on the MAR, his labs and imaging are all done and the reports are in the chart for your review and there are no criticals, his vital signs are stable as documented in the flowsheet, he's A&Ox4 as documented in the flowsheet... OK, he'll be there in 5... once you see the patient, call me if you've got any questions"

Having the information documented DOES provide continuity of care.

[MunoRN, RN]

Altra, your post has no basis in reality. I have seen data from the telemetry floor of a hospital that shows consistently a cluster of admissions from the ED from 6 am - 7 am and from 6 pm - 7 pm. And this is not just one day. It is many many days. A "coincidence"? I don't think so.

In the ED's I've worked in that is an MD issue. The Doc's don't hand off their patients to other ED docs, their patients are theirs until they get discharged or admitted, and for some reason Docs tend to let their admits accumulate and then write all their orders at once, usually in the last hour they are there.

I've worked with some very good Nurses in every ED I've worked in, although that doesn't mean it's completely false to say that some ED Nurses aren't as conscientious as we should expect, there are certainly some who's only goal is to get rid of every patient starting the minute they get them while doing as little as possible. I don't think we generalize that all ED Nurses are like that, but lets not pretend they don't exist.

[MunoRN, RN]

I have little patience for things that annoy me in general, and I want to throw the phone against the wall whenever the Nurse I'm giving report to asks where their peripheral IV is, but I really can't imagine just not giving a report. Not properly communicating what we've assessed and done in the ER makes all of it kind of pointless, not to mention I've been involved in reviews of situations where things went bad due to a bad report, no report is just means I have to hear even more stories of where we messed up even though it was easily preventable.

I'm really struggling to understand... how is the EMR hand-off report *not* communicating?

The theme here seems to be that if it's not done by voice then communication is not happening.

For that matter, why are people so attached to *hearing* somebody *tell* them lab values when that process will NEVER be 100% accurate while the chart *is* accurate (or at least what the docs are basing their decisions on.)

IMO, having been on both sides of the floor-vs-ED divide, as well as taking on pt assignments for lunch breaks, etc... the only thing that's particularly important to specifically communicate would be (a) potentially violent/volatile patients and (b) high-fall-risk patients who've been trying to climb out of bed. Everything else is - or should be - immediately and quickly visible in the chart.

That said, I've used some atrocious EMRs (cough-next-cough-gen) in which information is so difficult to retrieve that they're all but useless for a nurse.

Regardless, the chart is where the actual information resides and anything the nurse says in report is an approximation thereof whose accuracy and completeness cannot be 100% presumed.

[Laurie52]

I'm really struggling to understand... how is the EMR hand-off report *not* communicating?

The theme here seems to be that if it's not done by voice then communication is not happening.

For that matter, why are people so attached to *hearing* somebody *tell* them lab values when that process will NEVER be 100% accurate while the chart *is* accurate (or at least what the docs are basing their decisions on.)

IMO, having been on both sides of the floor-vs-ED divide, as well as taking on pt assignments for lunch breaks, etc... the only thing that's particularly important to specifically communicate would be (a) potentially violent/volatile patients and (b) high-fall-risk patients who've been trying to climb out of bed. Everything else is - or should be - immediately and quickly visible in the chart.

That said, I've used some atrocious EMRs (cough-next-cough-gen) in which information is so difficult to retrieve that they're all but useless for a nurse.

Regardless, the chart is where the actual information resides and anything the nurse says in report is an approximation thereof whose accuracy and completeness cannot be 100% presumed.

Because communication is a two-way street. Not only does information have to be given, it has also to be received and understood. There are things that will make the nurses day much smoother such as issues with the family or particular issues with the patient that are not necessarily in the emr. Just reading the emr doesn't allow the receiving nurse to ask for clarification of anything such as we're supplements given or which of the three abx were started.