ED tranfer.. No verbal report required

applesxoranges, BSN, RN · Feb 17, 2014

I would find out from other nurses why they are not doing a verbal report. Was there an issue in the past of people hiding to avoid getting an admission?

I would also find out what it is required by your nurse practice act. Ours defines the requirements of hand off.

kjnsweets · Feb 17, 2014

We do something similar but if they call and the sbar has not been faxed we do not take report. It's all about safety and making sure the patient is stable before they are sent up

SionainnRN · Feb 17, 2014

The hospital I just started at doesn't do verbal report. There's a floor report note that is edited by the primary nurse with the pertinent info as soon as the pt is up for admit. It can be updated as things change since it can take up to 30 hours to get a bed sometimes. It's is the floor nurses responsibility to look over the floor report when they are assigned the pt. once we get the room we call up to make sure they have read report, answer any questions and head up. It works pretty well.

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FlyingScot, RN · Feb 17, 2014

I work at a facility that has no policy regarding the need for nurse to nurse verbal report when a patient is admitted to a unit from the ED. When the ED feels like it, they fax the ibex report and pertinent information to our floor, and bring the patient up when they feel like it.
Gee, I don't know. Maybe your low opinion of the ER nurses is coming through to them making them less than open to dialoguing about the problem. Having worked in the ED I can pretty much say they aren't doing anything based on when they "feel" like doing it but rather in response to when they are told the bed is ready and as soon as they are able to. Sorry, this just got my hackles up.
I have never seen this. It's unsafe patient handoff, and many of the times the med history or med list from the ED hasn't been updated, so we have no idea what meds the patient has or has not had.
If this is actually happening then you DO have a beef with the ED staff. However, often the med history cannot be completed because the patient is waiting for a list to be brought from home but they should be documenting meds given in the ER. I suggest you start here as it is reasonable for you to expect accurate medication reports.

I am now requiring a verbal report from the ED nurse when I am expected to take an admission. I don't feel comfortable otherwise, but the reactions I'm getting aren't very supportive. It seems as though it's going to be an issue. Any thoughts?

Then I hope you are making yourself immediately available to recieve report rather than putting them off repeatedly which is why faxed report was started in the first place.

This is pretty much the way many ED's are choosing to go. Most have a form that is filled out and faxed 15 minutes before the patient is brought up. This gives the receiving nurse or charge nurse a minute to quickly review the info and formulate pertinent questions if needed. If both parties do their part ( faxing and reading)then it usually works out well. Of course there will always be those times when something goes awry on either end. I would give a verbal heads up if there was something unusual about the situation/patient or if there were any problems which I know the floor appreciated. What I did not appreciate was being grilled on exact location of IV's, I&O's irrelevant to the admitting diagnosis, why the doctor was admitting them there instead of some other unit, etc., etc.

I think approaching this more as how can "we" facilitate a smoother admitting process is going to get you much farther than by taking the adversarial approach evident in the first part of your post. Perhaps you had just finished a particularly bad shift and were feeling dumped on but if that is how you really feel about the ED staff I'm pretty sure it's being communicated to them.

psu_213, BSN, RN · Feb 17, 2014

I am now requiring a verbal report from the ED nurse when I am expected to take an admission. I don't feel comfortable otherwise, but the reactions I'm getting aren't very supportive. It seems as though it's going to be an issue. Any thoughts?

When I worked on a telemetry floor, here was the original procedure: once the ED "requested" a bed, the nursing supervisor would assign a bed and that floor would receive a page that they were getting a patient into such and such room. The ED nurse would then record a taped telephone report. The floor would get an automated message from the report system that a new report was in. The floor nurse would listen. If they had questions, it was on them to call the ED. Otherwise, the ED would bring the pt up in 20 minutes with no further communication.

Well, one night, we got a page for a new pt. 25 minutes or so later the pt was brought up by the ED nurse. When asked why we never got a report, she said "oh, our manager decided that [the telephone report] takes too long, so she said they we just fax a written report, which I did, and then bring them up in 20 minutes." Well, we had no idea that such a change was being made, but the change stuck. The faxed report is basically a simplified assessment form with "level of orientation," "IVs," "medications," and a few others. In other words, pretty unhelpful. Due to a lack of strong hospital-wide leadership, and a "strong" ED NM, there was no way for the floors to fight the change, despite the system not being the pinnacle of safety. If you are not going to be backed up by the powers that be, you will never be able to get the system changed.

Now I work at an ED in a different hospital in the system. If we sent a person to the floor without a verbal report, there there is not a computer with enough processing power to handle how fast that incident report is going to be filed.

psu_213, BSN, RN · Feb 17, 2014

We do something similar but if they call and the sbar has not been faxed we do not take report.

To the OP: I'd be cautious with this approach. At least at my hospital, there is no quicker way for a floor nurse to have the nursing supervisor (and up from there) breathing down your neck than to "refuse" to take report.

jallen326 · Feb 17, 2014

I have worked on the floor- med surg and oncology and then my last 5 years has been in the ED. I must say we use to have give telephone report via voice care but they went back to direct verbal telephone report. With these new mandates that require ED patients to be seen and dispositioned in 4 hours it makes it even more difficult. When we get admit orders we have 30 minutes to get the bed and then get the patient to the floor. There has been times when I call to give report and I am put on hold for 5-10 minutes for the floor to decide which nurse gets the next patient. I then have to call back and be put on hold waiting for the charge or resource nurse to take report. It gets frustrating which is why I see they resorted to faxing reports. We still have problems but now that we decided to write up the floor when there is a delay in giving report, the powers that be are now aware of the problem and is now trying to put a process in place to not delay the patent leaving the ED. I guess if you guys encounter situations where safety is a concern then do an incident report. I know the floor can be busy but once your unit is full then you can't get anymore patients. This is definitely not the same in the ED. We can't stop rescues and ppl from coming even if we are full beyond capacity. So as nurses we need to work together instead of against each other since the ultimate is the well being of the patient!

MunoRN, RN · Feb 17, 2014

Then I hope you are making yourself immediately available to recieve report rather than putting them off repeatedly which is why faxed report was started in the first place.
This is pretty much the way many ED's are choosing to go. Most have a form that is filled out and faxed 15 minutes before the patient is brought up. ....

I really don't think that "most" EDs are doing it this way, it's more likely that most EDs follow the various patient safety recommendations that handoffs be verbal and interactive. And actually in my state a written only report is considered abandonment, so it's likely very rare.

FlyingScot, RN · Feb 17, 2014

I really don't think that "most" EDs are doing it this way, it's more likely that most EDs follow the various patient safety recommendations that handoffs be verbal and interactive. And actually in my state a written only report is considered abandonment, so it's likely very rare.

I'm sorry, apparently I over stated it, "many" EDs (except in yor area) are switching to this.

MunoRN, RN · Feb 17, 2014

I'm sorry, apparently I over stated it, "many" EDs (except in yor area) are switching to this.

The recommendations for a verbal/interactive handoff aren't regional and limited to my area, they also come for organizations at the National level; AHRQ, CMS, WHO, JC.

That Guy, BSN, RN, EMT-B · Feb 17, 2014

My old hospital when I worked the floor would only receive an SBAR faxed to us. We would only get verbal report if their was something crazy about the pt. It wasn't a big deal. You can figure most the stuff out from the chart, the SBAR and talking to the pt. Now that I work ER, we have to call report and it can be a pain a lot but it works too. I just don't like when the receiving nurse uses the time to ask every question that can be answered by the pt just as easily.