Calling Report to ER from Urgent Care

[misdetermined]

Im wondering for all the ER nurses out there, what do you expect to hear know when getting report from an urgent care center when referring a patient. Sometimes i get put on hold for extended periods of time or the nurse seems too busy to receive report or i get drilled for a whole health history when I only just met a patient a few minutes ago. I know you ER nurse are busy, but when I call to give a heads up, I am doing this as a courtesy or at least I think I am. My facility does not have a mandatory policy to call the ER when providers are referring patients over to ER. When I call I usually provide:

Name

DOB

Complaint

Pertinent history

Results of abnormal labs

Any meds given

Mode of travel

This takes about 2 mins tops. What else should I add? Just want to make sure that Im giving the best and most efficient report. TIA :)

[PeakRN]

As far as I know, there is no legal requirement for an UC to give an ED report on a pt they are sending over. I know I have gotten plenty of pt's from an UC without report (of they call after the pt has been in the ED for over an hour).

A patient being referred to an ER may, or may not be a transfer.

But, even if it is a transfer, are you sure that nurse to nurse is a requirement? Maybe a facility rule, but is it required by EMTALA?

7. What is an appropriate transfer?

An "appropriate transfer" (a transfer before stabilization which is legal under EMTALA) is one in which all of the following occur:

• The patient has been treated at the transferring hospital, and stabilized as far as possible within the limits of its capabilities;
  
• The patient needs treatment at the receiving facility, and the medical risks of transferring him are outweighed by the medical benefits of the transfer;
  
• the weighing process as described above is certified in writing by a physician;
  
• the receiving hospital has been contacted and agrees to accept the transfer, and has the facilities to provide the necessary treatment to him; No mention of nurse to nurse.
  
• the patient is accompanied by copies of his medical records from the transferring hospital;
  
• the transfer is effected with the use of qualified personnel and transportation equipment, as required by the circumstances, including the use of necessary and medically appropriate life support measures during the transfer.
  

While I agree it is best practice, I don't think it is a law or regulation.

EMTALA is not the only law governing the need to give report. Before anybody claims that there is no need to give report on a patient who has been deemed to be sick and need a higher level of care, I would check very carefully with your state board of nursing. There is legislation around neglect, patient abandonment, failure to act, dereliction of duty, et cetera at the state level that could apply if you are not providing appropriate care including the continuation of their care when they are going to another facility.

In the same way EMTALA doesn't necessitate me giving report when I'm transporting a patient to the hospital from the field, however I cannot legally leave the patient in a room and walk out of the ED without giving report, that would be abandonment.

Regardless of the legislation you have a duty to the patient as their nurse to give a report if you have an existing care relationship.

[CBlover, BSN, RN]

I'm an ER nurse and I want basically the chief complaint, tests run, and maybe age. That's it. We'll get all the info ourselves anyway so why waste their time and ours.

[Kooky Korky, BSN, RN]

Ideally our charge nurses take report on any patient being sent to us, I don't decide who is going to take a patient until I get the call from EMS or they arrive, the ED is far too dynamic for me to routinely mark off a room for an unknown amount of time for a transfer. That being said any of our nurses who are allowed to take EMS radio/phone reports can get a sending facility report. There is no reason to be on hold for an extended period of time.

As far as what I want to know varies just like any other ED patient. Report for a amputation should only take 30 seconds or so; a critical or complex patient will require a much more detailed report (similar to what a ICU/PICU nurse will be expecting from me).

If you have an established nursing relationship with a patient you are required to give a nurse to nurse report on a transfer, it is not a courtesy.

But plenty of ER nurses have told me I needn't have bothered calling Report when sending pts from nursing homes or Rehab/Skilled Care. So I started just letting Paramedics give Report when they got the pt to the ER. Sometimes I faxed Report to the ER.

[bgxyrnf, MSN, RN]

The "heads up" calls from the clinics and urgent cares are needless... the patient is going to be triaged on arrival which includes a focused assessment and a review of the diagnostic results which will presumably be sent along with the patient.

Often patients arrive with the expectation of direct rooming because someone from the clinic "said that they would call to let you know I was coming." They often get frustrated with the triage and even more frustrated when they end up waiting.

[cretin, ADN]

i'm not sure it is required in all areas to give report from an urgent care to an ER. In my area, it is not even required to get bed acceptance to go from one ER to another. I think it is a curtesy to call ahead with info, but not required.

[DowntheRiver]

The "heads up" calls from the clinics and urgent cares are needless... the patient is going to be triaged on arrival which includes a focused assessment and a review of the diagnostic results which will presumably be sent along with the patient.

Often patients arrive with the expectation of direct rooming because someone from the clinic "said that they would call to let you know I was coming." They often get frustrated with the triage and even more frustrated when they end up waiting.

I don't disagree with you, since this is only required of me if the pt. goes via ambulance and I give report to the medic. However, it is in my company's policy to call so of course I'm going to call. It may be the company's policy to call report.

[Susie2310]

Some patients go to the Urgent Care with symptoms that are actually emergency medical problems or that will pose a threat to life if they don't receive prompt medical evaluation and treatment. These situations can be further complicated if the patient already has other significant medical problems. One can't assume that just because a patient presented to the UC on foot instead of the ED by ambulance that they don't have a life-threatening condition that requires prompt medical evaluation and treatment.

A family member who was sent from the UC to the ED and was cautiously allowed to travel by private vehicle with a driver was told to inform the staff at triage that they are a complicated patient and were sent by Dr. X from the UC, and told to give the triage staff their UC paperwork. They were met at the triage by an ED physician and taken to a room immediately. The only staff who provided care to my family member at the UC were the physician and a couple of MA's; no nurses provided care, and the physician said that he/she would call the ED and let them know of my family member's condition/other medical problems, etc., and that the ED would be prepared to receive him/her, which they were.

Receiving report in the ED from the UC is important, especially for complicated patients and/or patients who have an increased risk of deteriorating based on their symptoms, other current medical problems, medical history, and for patients who are elderly or very young. Requiring that UC patients go through triage, be assigned a triage rating by a nurse (which may or may not correctly reflect the urgency of which they should be seen), and wait in the waiting room, slows down the care of patients who need prompt ED care when they have already been seen by a physician in the UC and the UC physician has determined that they need prompt care in the ED. Communicating in UC to ED report CC/symptoms and their onset/severity/duration; vital signs; assessment; lab results; diagnostic test results; treatment given; current medical problems/medical history, patient's age; medications the patient takes/has taken; and patient response, can be very important for the patient.

[JKL33]

Requiring that UC patients go through triage, be assigned a triage rating by a nurse (which may or may not correctly reflect the urgency of which they should be seen), and wait in the waiting room, slows down the care of patients who need prompt ED care when they have already been seen by a physician in the UC and the UC physician has determined that they need prompt care in the ED. Communicating in UC to ED report CC/symptoms and their onset/severity/duration; vital signs; assessment; lab results; diagnostic test results; treatment given; current medical problems/medical history, patient's age; medications the patient takes/has taken; and patient response, can be very important for the patient.

There's no reason that an ESI would be less accurate based on the patient coming from UC. Nurses assign the acuity of nearly every patient seen in every ED in this country and we do far better than the crapshoot you suggest. You make a good point about the patient who has been seen by a physician and determined to require prompt care, though. Unfortunately the determination that someone requires prompt care is more subjective than one might think, such that in the grand scheme of things it's a good idea for most patients to get a triage look. If one of our attendings has received report on a concerning-sounding situation, we will be there promptly as it sounds like you experienced.

I do know what you're saying. It's just that bypassing triage due to already having been seen by someone doesn't work as a general rule.

[Susie2310]

There's no reason that an ESI would be less accurate based on the patient coming from UC. Nurses assign the acuity of nearly every patient seen in every ED in this country and we do far better than the crapshoot you suggest. Unfortunately the determination that someone requires prompt care is more subjective than one might think, such that in the grand scheme of things it's a good idea for most patients to get a triage look.

I do know what you're saying. It's just that bypassing triage due to already having been seen by someone doesn't work as a general rule.

I'm not suggesting that an ESI would be less accurate for a patient coming from Urgent Care specifically; the accuracy of triage for all patients varies depending on a number of factors, for example, the experience and training of the nurse doing the triaging, and, as I said, may or may not be accurate.

[JKL33]

I'm not suggesting that an ESI would be less accurate for a patient coming from Urgent Care specifically; the accuracy of triage for all patients varies depending on a number of factors, for example, the experience and training of the nurse doing the triaging, and, as I said, may or may not be accurate.

As is the case for all assessments, including those made in outlying facilities. If someone arrives at UC with a condition that requires ED services, that's often fairly clear. But it doesn't translate to needing an ED bed immediately and bypassing the only system we have for utilizing our resources properly to care for those who shouldn't wait (as a rule).

[Susie2310]

As is the case for all assessments. Including those made in outlying facilities.

You seem to be taking my comment personally, but I personally will take an Urgent Care physician's assessment that I or my family member needs to be evaluated and treated promptly in the ED over an ED triage nurse's ESI rating.

[Susie2310]

If someone arrives at UC with a condition that requires ED services, that's often fairly clear. But it doesn't translate to needing an ED bed immediately and bypassing the only system we have for utilizing our resources properly to care for those who shouldn't wait (as a rule).

I already provided an example of a situation that translated to needing an ED bed immediately. The patient had a diagnosis and assessment findings that could very quickly lead to loss of life or severe permanent injury without prompt evaluation and treatment, and was a complicated patient. No-one is saying that ALL patients from the Urgent Care regardless of their diagnosis and assessment by an Urgent Care physician should immediately be given a bed in the ED.