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 :)
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.
Not at all.
I am separating an assessment of "you will need to be treated in the ED" from "this is an emergency of the highest order." That is all. Sometimes it is very urgent and sometimes less urgent.
When two physicians coordinate the care of a patient with urgent needs, it generally works well and is obviously in the patient's best interest. This isn't about taking anyone's assessment over anyone else's or needing to worry about bypassing anything. It all works out.
I have worked in an ER for 15 years and have never gotten report from an urgent care center. Not once but I'm cool with that. In my experience these patients are not that sick. On a couple rare occasions we got patients in an ambulance from urgent care centers but then the ambulance guys gave report. Honestly as an ER nurse I much prefer short reports. Usually if I have to pick between a short report and some long blab-a-thon session from a nursing home or another facility I'd choose no report
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.
It could be company policy and it could just be one of those institutional momentum things.
For example, many nurses with whom I work perform needless 2-nurse med verifications because they've taken a specific policy and broadly applied it to situations to which it unambiguously doesn't apply. So many people do it now that the newbies are picking it up in orientation and speaking it back to me as though it's a fact...
Nursing has so many things that get purported as fact or policy or best practice when they simply are not... and often when pressed, people get weird about it rather than seeking or accepting the alternative.
Outside of a STEMI or a stroke, there's really no need to call ahead; and for goodness sake, if you DO call ahead, DON'T tell that to the patient because it really does create needless problems in triage.
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
I can't tell you how many times we get patients from the clinics and urgent cares who arrive with the belief that they have some serious, life-threatening condition as stated by the doc in the clinic when they clearly do not.
Awhile back we had a teen come in who was diagnosed as being in DKA by the clinic doc who quite obviously was not. Of course we did a thorough work up before sending her home but any experienced ED nurse or doc could immediately tell she wasn't in DKA.
All patients, EMS or walk-in, from home or from a clinic, get triaged and prioritized based on our assessment, not report. Even a reported STEMI or stroke alert is treated the same way as if they had walked in to the lobby. In the years that I've been playing the ED game, from Level None to Level One, adults and peds, I've yet to see an example that would tell me that this is not the right approach.
On the contrary, I've have seen a number of patients direct roomed based on report who should, in fact, have gone behind a triaged patient from the lobby... or patients for whom report indicates a likely ESI 3 when they are actually an ESI 1.
Of course, any diagnostics that were already completed I want to immediately see in hard-copy but a telephone call? Generally not terribly useful in my experience.
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...
And while sometimes those docs are actual ED docs who are moonlighting, they're just as often non-EM docs with limited experience.
I like the idea of calling (receiving) a brief report because although it can be more or less useful in some of its permutations, it seems more prudent than totally disconnected care episodes related to the same problem.
In the ED we're set up to juggle whatever comes through the door, so in that regard its probably not necessary the grand majority of the time. By that line of thinking, neither is knowing which ambulances are headed our way since numerous EMS patients could just as well be unstrapped and put in the WR, too.
I guess I could go either way. I don't think it probably sits very well with a patient to be triaged and assessed by someone who approaches starting from square one.
JKL33
7,041 Posts
Not at all.
I am separating an assessment of "you will need to be treated in the ED" from "this is an emergency of the highest order." That is all. Sometimes it is very urgent and sometimes less urgent.
When two physicians coordinate the care of a patient with urgent needs, it generally works well and is obviously in the patient's best interest. This isn't about taking anyone's assessment over anyone else's or needing to worry about bypassing anything. It all works out.