Admission times

KatieBell · Oct 21, 2005

One thing that REALLY helped our admission times was to do a tubed report (rather than a verbal one) to the Med SUrg floors. The Floor designed the paper: on it had the information that they decided they wanted- it included

Name age Dx meds meds given in ed with time, iv access, other tubes (foley NG etc), last vitals and a few other things. When we got a bed we filled this thing out and then sent it to the floor- then 1/2 an hour later we sent the patient up. Cut down on the "That nurse can't come to the telephone, can you call back in ten minutes" deal. (Because where are you going to be in ten minutes- by the time you get time to sit down and call report again, it's 25 minutes or more!)

Unfortunately I don't know the time, but it's a priority in our ED, if we aren't fast enough the team leader calls report for us and instructs us to get the patient up. As a sometimes team leader, this does unfortunately put a strain on some nurse to nurse relations....

ckh23, BSN, RN · Oct 21, 2005

When a bed is ready we try calling report once, if the rcving nurse cannot take report for whatever reason, then we fax it and send the patient up.

katger · Oct 30, 2005

I am looking for any research into faxed report for a papper. If any one knows of any let me know. I may get my BS by 2010 if I continue at the pace I am going

Aneroo, LPN · Oct 30, 2005

When a bed is ready we try calling report once, if the rcving nurse cannot take report for whatever reason, then we fax it and send the patient up.

Hehehe... If you tell the secretary "Oh, they're busy? I'll just do a fax report and then send them up", that nurse usually finds a way to get on the phone fairly quick!

ERNurse678 · Nov 2, 2005

We tube report. We have computerized charting and we print a copy of the chart, tube it to the floor, give them 15 minutes and take the patient upstairs ourself. We have transporters until 3am in the morning, after that the RN has to transport. Every month each nurse gets an individual report in their box that tells us what our average admission times. The report breaks down into times for bed ready-report sent, and report sent to patient discharge and bed ready-patient discharge. We try to get our average time for bed ready-patient discharge in the 30 minute range. This past month our patient satisfactions scores dropped and the biggest complaint was the time that it took to get admitted, so that is our goal!

TexasPediRN · Nov 2, 2005

I also think that it is good to make certain times that you cannot send patients to the floor, such as the first and last hour of each shift. For instance, a nurse working 3-11 cannot receive a patient from 3-4p and from 10-11p.

This is just my opinion however, but the floors are always crazy during the first and last hours, and I dont think its fair to send patients when a nurse is still getting report.

I guess it works both ways, the floor knows they wont be there late with an admission, and the ER works to get the patient up to the floor before 10pm for a 3-11 shift. Cuts down on overtime since the evening nurse wont have to stay late to do an admission/catch up on charts/give report.

Just my 2 cents though!!

As for giving report from the ER- we fax it. Then the floor usually calls down when ready. My floor was pretty good about getting patients in a decent amount of time, but there should be a time limit as well. ie, take patient within 30 minutes once report is faxed.

I have found though that its not just the floor and the ER, if housekeeping is behind- you cant take patients. If transport is behind d/c'ing a patient, housekeeping cant clean, then the floors are behind.

Its just a vicious circle..

DusktilDawn · Nov 2, 2005

med-surg nurse here. the volume of patients that arrive on our unit at change of shift is astounding. it's interesting how all the patients in rr are suddenly stable right at shift change (and after only being in rr for 15-20 minutes). it's also interesting how suddenly beds that have been empty for almost 12 hours, have 2-4 patients arriving from er at the end of shift, when the mds & residents are doing rounds, dietary is delivering breakfast and when you find the fax report, you observe that this patient could have been admitted hours ago. basically what is going is rr and er fax reports and "oh well" if we're not sitting on top of the fax machine. patients are arriving unexpected with the staff having had no idea they were coming. i find the method of faxing reports has been abused to the detriment and safety of the patients at our facility.

this is a letter i e-mailed and the response i received from nursing spectrum in regards to faxed reports:

what are the laws concerning transference of patient care? - by madeline on may 24, 2005

dear nancy,

i work in an institution as a rn where it is policy to receive faxed reports only when we receive patients from the ed or rr. there are numerous problems with this system of reporting. for instance, if the fax machine is not working, the unit receives no report prior to the patient's arrival and has to call the department where the patient came from to obtain a report. the faxed ed reports are in extremely small in print and scant or no information about the patient history is provided. faxed reports from rr basically provide only the procedure done, one set of vs, drains if any, and whether the patient received pain medication.

i feel very strongly that transferring care of a patient from one department to another should involve a verbal report that allows the nurse who will be receiving that patient to ask, get pertinent information concerning the patient's condition, and be made aware of other medical conditions the patient may have. what are the laws concerning transference of patient care?

madeline

nancy replies:

dear madeline,

a verbal report when a patient is transferred to any unit (and at the end of each nursing shift) is a long-standing standard of nursing practice. a verbal report (face-to-face preferred, but at least a telephone report), allows the nurse transferring the patient to inform the nurse receiving the patient about the patient's diagnosis or surgery, treatment provided, and reactions to treatment (as examples). it allows the nurse receiving the patient to seek clarifications and obtain additional information before doing a nursing assessment and initiating care.

such a verbal or telephone report can be organized as best as possible to use the time wisely, and at the same time, provide needed information so that it is complete, accurate, and as concise as possible. for example, when a patient is transferred from the recovery room, one area of concern for the receiving nurse would be information on how the patient tolerated anesthesia, vital sign stabilization, and the patient's current level of pain.

whether the report is oral, in written form, or perhaps audio taped, the report must be incorporated into the medical record. with the current practice, that would mean the faxed report is placed in the medical record and any specific follow-up documentation recorded. with an oral report, the contents must be documented either by the nurse giving the information to the receiving nurse or the receiving nurse himself or herself documenting what was shared and by whom. regardless of the form of the report when patients are transferred, facility policy should be followed. if one does not exist, a policy should be developed and adopted by the institution.

if the transferred patient suffers some injury or dies after the transfer takes place, all those involved in the patient's care, including the transferring nurse and the nurse to whom the patient was transferred, would more than likely be named in the suit. this would be especially so if the documentation concerning the transfer, and what was done after the patient arrived on the unit, is legally insufficient or non-existent.

perhaps sharing your concerns with risk management might be a good idea. if nursing has been filing incident/occurrence reports with the department when the faxed reports haven't arrived, the risk manager can hopefully review those filed reports and, with input from other departments (e.g., quality assessment), revamp the current procedure for transferring information about patients who are sent to units from the ed or rr.

sincerely,

nancy

http://www.nursingspectrum.com/careermanagement/asktheexperts/law/detail.cfm?id=598

btw nursing spectrum changed my name, i did not ask for my name to be changed. i have real issues where faxed reports are concerned. i showed this letter to my um because i wanted it forwarded to risk management.this letter has made it's round about the facility i work at and now they want to look at improving communication in this area. patients should not arrive on any unit at any time, irregardless of what is going on that unit, with staff unprepared or unnotified, and the staff on that unit be left entirely out of the loop in regards to the admission process.

apparently the "pumps and pearls" group have finally noticed that our los is too long for admissions. my boss asked me to sit on a committee to improve our times. we are brainstorming ideas to decrease this time.
does anyone have anything that worked out well at their facility?
also, what is your eds average time from admission to bed?
thanks for your help!
anna

how about including floor nurses and admitting on this committee. contrary to popular belief, we do not appreciate patients arriving at shift change. each area of nursing, whether it be er, icu, ccu, or med-surg has issues also.