Admissions

[nightsinBoston]

How do you get admissions from the ER? Verbal report, computer generated? Do you feel ready to take care of your patient?

[loopylou4]

At my work place we have a standard handover sheet which the ED nurse uses as a template to give a verbal handover to the ward nurse who writes down the info on an identical form. I find this really healpful as it is quite systematic and is useful for prompts.

[icuRNmaggie, BSN, RN]

We have an electronic report that the ER nurse fills in on the computer. When they call the floor to give report to the nurse taking the admission that nurse can pull up the eletronic report on theor computer and read along and ask questions. It's great because you don't have to write down anything

and if you can't remember something from the report you can just pull it up and reread it.

I absolutely love this idea of an ER Nursing summary. We certainly have the technology to build this so that the data imports from the EMR.

It would solve the issue of change of shift handoffs. There would be accountability for those occasions when report doesn't match the patient. Not just for the ED but for any transfer to another unit.

[elizzyRN]

At my hospital, we (floor nurses) go to the ED to pick up new admissions and we do bedside report there with the ED nurse and ED provider. I really like it. We get a good overview of the ED course and plan going forward, we get to ask all our questions, and the providers are really good about putting in orders for things like pain meds, diet, or other things the patient might need on the floor before the admitting doc sees them and gets the orders in. I think it is worth the time spent going downstairs and transporting the pt to the unit.

[ixchel]

When I was greener and wetter behind the ears, I felt like I HAD to know EVERY. LITTLE. THING. OH EM GEE HE MIGHT DIIIIIEEEEE!!!!!!!!!

Then one day the thought occurred to me that I'm asking the ED nurse, who likely forgot a ton of tiny, pointless details. So now when the nurse first shows up and we're just getting started loading the patient onto their bed, I say to the patient, "you've had a bad day, huh?" That's when the patient will tell me everything the nurse might tell me (possibly with mixed up details), and that I was going to ask the patient as part of their history anyway. That usually breaks the ice completely. The patient will talk about their last few days, the nurse will chime in with ED details.

I really don't need more than that. The rest is in the chart. When the patient is a&o, they give me all the report I need. If the patient is not a&o, a little background is nice, but probably the h&p by the hospitalist did just fine giving all needed details.

Transfers from other floors are different, though. That should be more detailed because it usually needs to be.

[LightMyFire]

We get a report faxed and then the ER nurse calls for a report. Usually I don't even want to talk to them unless I have a question because they want to give me a lengthy report that covers my faxed report as well as details I'd get from my own assessment. Sometimes the info (or something about the patient) seems sketchy so I'll get on the line. But usually I'm way too busy and our ER nurses usually send a very thorough report.

[ScrappytheCoco]

I have worked a few places where we call report to the floor, but generally we just fax an sbar and call to say we are coming. If there's something I really feel like needs to be addressed, I'll call out of courtesy. ICU/Cath Lab/etc always get a verbal bedside report. We do have a lot of good rules for admissions as well, such as no transfers to the floor or ICU between 1830 and 2000, no unstable pt leaves the ED (unless they're going to Surgery or Cath Lab, obviously). If the patient is clinically unstable and the ED is in the "Red Zone" (a numbers game computed by the charge nurse that has to do with safety in the department related to the number of critical care patients, total number of ED patients, and the number of docs in the department) then they can be transferred to ICU but only if the ED and ICU charges agree. It does save a ton of drama.