Any tips for getting patients transferred faster?

NicoleERRN, RN · Nov 30, 2007

Ok. my two cents. basically what i try and do... (not always possible). when you first know your pt is admitted fill out your report sheet at that time, you can always add to it later if need be. stay current on your vitals so that when they have a bed. you dont have to take extra time to do that. when you recieve your bed # fax or call report (however your unit does it) and once the unit confirms recd fax, copy chart( or however your unit finishes charting ) and up they go! Most of my waiting time is waiting for a bed from the unit. as long as i am current with my end, once the bed is ready it only takes 5 min. this is how our ER does things i'm sure it is different for you

Hope this helps!~! Stick with it !! IT will get better

SarasotaRN2b · Nov 30, 2007

Okay as a unit coordinator on a tele floor...if you want to get a patient transferred fast, don't do it during shift change (i.e. between 7 and 8). This is the most hectic period on the floors with getting report from off-going nurses and the initial intros to their patients). A major pet peeve I have is that the ER must give report between this hour and yet we don't see the patient for hours. I know it can be crazy in the ER at times, but it is no less so on the floors. While yes, every once in a while there is no choice...but I would say that more times than not...report can be given to the floors after shift change. I know that whenever we get notice that a patient is coming from the floor from the ER, the nurse who will be receiving that patient is able to get some information from the computer chart which thus makes your job easier...just give them the time to look up the patient. We'll sometimes get beeped that a patient is assigned and not 30 seconds later, the ER will call up.

Kris

alkaleidi · Dec 1, 2007

Okay as a unit coordinator on a tele floor...if you want to get a patient transferred fast, don't do it during shift change (i.e. between 7 and 8). This is the most hectic period on the floors with getting report from off-going nurses and the initial intros to their patients). A major pet peeve I have is that the ER must give report between this hour and yet we don't see the patient for hours. ... We'll sometimes get beeped that a patient is assigned and not 30 seconds later, the ER will call up.

I don't know how it is at your hospital, but I know that where I work, when I come on shift at 7pm it is absolute chaos and there are probably at least 3-5 patients if not more with "Admit" next to their name on the Tracking Board (our computer program) in the ED. Add to that 20+ angry people sitting in the waiting room needing to come back to the ED and be seen and treated. What are we supposed to do with those patients to be admitted -- hold them in the ED for an hour or more so that the admitting floors can get settled? We need those beds for people who have yet to be seen. I think it's unrealistic for the floor to ask that the ED not transfer patients up during shift change when yes, it's busy for you, but it's also busy for us. I guess the difference is while yes, we could let them sit for an hour or two in a room in the ED, you could let them sit for an hour or two on the floor as well, and if they are at least up to the floor, we can fill that room sometimes twice during the time you want us to wait to give report.

JLARN77 · Dec 1, 2007

I have been working in our ED for one year, and understand exactly what you are saying. I felt the same way when I first started, trying to figure out what the other nurses were doing that I wasn't... and I found out that it just took me time to get more comfortable with the process and I am now able to do it just as quickly as anyone else. It is kind of like any new skill we learn the more we do it the better we become at it. Good luck and it will get easier and faster.

alkaleidi · Dec 1, 2007

So I'm about to start my 9th shift on my own. New grad in the ER, I had a 3 month orientation, and now I'm working nights. I'm still slower than everyone and feel like people have to pick up my slack at times, but the thing that slows me down the most is having to transfer admitted patients up to the floors. If we have a monitored patient they have to go with a nurse. The process of getting a room assigned (never know if and when you'll get one), finishing the paperwork, giving report to the floor, and then getting the patient up to the floor and getting back down takes me forever and then I feel like I'm behind forever. Any suggestions or tips. I feel like the more experienced nurses around me get this done much faster, I've tried watching what they do, but am so busy its hard to take a minute to observe anyone else. Thanks =)

I agree with what Nicole said...

Once you know you have someone that is going to be admitted, gather your thoughts and maybe jot down pertinent things for report (fresh vitals, significant lab values, etc)... be ready so that as soon as you get a bed you can call up and give report to the nurse taking the patient. Make whatever copies you need to (IE we have to copy the face sheet and charge sheet to give to the secretary in the ED) and fill out those things. Complete whatever other paperwork you need to.

When I'm admitting someone, and I am not required to go up with the patient, I generally utilize a tech to transfer the pt to the floor for me if one is available. If I don't have 2-3 other pts that need my care, I'll take the pt up myself, but if I have other things going on, my thought is that while I can and am willing to do all the things techs can do, they can't pick up my slack while I'm off the floor, so when possible, I delegate.

Other than those things, just know that it takes EVERYONE time to get a smooth routine, and even then, there's always stuff that comes up that delays transfers. When we call report to the floor and a nurse is not able to take report, they have about 10 minutes to return the call. If they aren't able, a lead or charge nurse is expected to take report for the pt's nurse. That's the policy where I work... I know it's not like that everywhere but it does make things better for us. We're busy and with the exception of between approx 2-5am, can't afford to have beds tied up with admits waiting to go to the floor.

Good luck -- things will get easier as time passes!

-A

NicoleERRN, RN · Dec 1, 2007

I don't know how it is at your hospital, but I know that where I work, when I come on shift at 7pm it is absolute chaos and there are probably at least 3-5 patients if not more with "Admit" next to their name on the Tracking Board (our computer program) in the ED. Add to that 20+ angry people sitting in the waiting room needing to come back to the ED and be seen and treated. What are we supposed to do with those patients to be admitted -- hold them in the ED for an hour or more so that the admitting floors can get settled? We need those beds for people who have yet to be seen. I think it's unrealistic for the floor to ask that the ED not transfer patients up during shift change when yes, it's busy for you, but it's also busy for us. I guess the difference is while yes, we could let them sit for an hour or two in a room in the ED, you could let them sit for an hour or two on the floor as well, and if they are at least up to the floor, we can fill that room sometimes twice during the time you want us to wait to give report.

Thank you for understanding!! not only is the waiting room packed, Charge wants to know when the room will be empty. pt thinks that they should have had a bed 10 hours ago, (dr told them we admit you and then you go upstairs !! ) yea ok... then you're told to pull this pt into the hall because you are going to get a run in that room, !!! Sometimes getting the pt to thier assigned bed only gets you BACK to full capacity and not OVER full capacity...

Ahhhh. the joys of an ER nurse!! Gotta LOVE it!!! :lol2: :lol2:

TRAMA1RN · Dec 2, 2007

When I know my patient is being admitted, I usually know within 5 minutes of assessing my patient, get my IV and labs drawn ASAP get my x-rays ordered and done, don't worry as you become more experienced you will definately know what needs done, talk to Doc in ER and get your chart in shape, as soon as the doc makes the formal decision to admit your report sheet should already be done, hopefully you can fax your report even without a bed assignment, copy all of your chart except your notes and doc notes and orders keep these and labs separate just in case residents like to steal your chart, as sson as bed is assigned call floor and confirm report was recieved and no questions, copy your notes and Doc's. Transfere your patient and give your zone buddy or charge nurse report on your other patients and transport your patient to floor. The room should be ready and bed prepared help transfere patient to bed and get back to ER ASAP.

SarasotaRN2b · Dec 2, 2007

I don't know how it is at your hospital, but I know that where I work, when I come on shift at 7pm it is absolute chaos and there are probably at least 3-5 patients if not more with "Admit" next to their name on the Tracking Board (our computer program) in the ED. Add to that 20+ angry people sitting in the waiting room needing to come back to the ED and be seen and treated. What are we supposed to do with those patients to be admitted -- hold them in the ED for an hour or more so that the admitting floors can get settled? We need those beds for people who have yet to be seen. I think it's unrealistic for the floor to ask that the ED not transfer patients up during shift change when yes, it's busy for you, but it's also busy for us. I guess the difference is while yes, we could let them sit for an hour or two in a room in the ED, you could let them sit for an hour or two on the floor as well, and if they are at least up to the floor, we can fill that room sometimes twice during the time you want us to wait to give report.

I'm not trying to get into a floor nurses vs. ER nurses...during shift change it is crazy in both locales. With our ER, shifts are staggered...not every one works 7 to 7. Yes, of course there are times that an admission will have to come through that time...but instead of calling to the floor with an attitude right away, realize that the floors want to accommodate these patients, but how does it help patients going from one stressful locale to another...and believe me, at shift change on the floor it can be pretty intense.

Oh, and by the way...the day you have no angry patients in the ER waiting room will be the day when you have no patients in the waiting room at all.

My next question is directed to those ER nurses who were floor nurses...what is your take?

Kris

rjflyn, ASN, RN · Dec 2, 2007

Another thing that might help is a change in policy. Our facility RN's only have to transport monitored pt's going to intensive care units, unless a paramedic is working I might add. Otherwise the hospitals transport staff take the pt's to the floor or at night the ED techs. On any given day 75% or more of the admitted pt's go to a tele bed or higher level of care by the way. Thats a lot of time for an RN to be off the unit.

Rj

alkaleidi · Dec 5, 2007

Oh, and by the way...the day you have no angry patients in the ER waiting room will be the day when you have no patients in the waiting room at all.
My next question is directed to those ER nurses who were floor nurses...what is your take?
Kris

What is your take on what? I worked Med/Surg/Peds prior to working in the ED. I agree this shouldn't turn into a floor vs ED nurse thread -- if you are wanting to discuss policy and practice regarding report-taking during shift change, perhaps you should start a thread on that?

It was my understanding that the OP was asking about improving her efficiency within the ED, and the process of a patient getting admitted and up to another floor in general, not specifically the task of giving report. I don't think that turning this into a debate of whether ED nurses should give report while floor nurses are in the process of shift change is going to be helpful to Aggie.