ED tranfer.. No verbal report required

FlyingScot, RN · Feb 17, 2014

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 well may be but I think recommendations from such esteemed organizations are of little comfort to the sick patients in the waiting room who haven't even seen a doctor because no ED beds are available while the floors play hot potato with new admits.

Look, I'm not saying it's the best way to do things but there has to be a way to balance the needs of everyone.

jallen326 · Feb 18, 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.[/quote']
I totally agree with you. Sometimes I feel like the floor nurse is using my own assessment to so their admission assessment.

LightMyFire · Feb 18, 2014

We do faxed SBAR and admit orders. I only want to speak to the ER nurse if the pt has dementia (are they climbing out of bed) or if there's something weird I need a heads up on. Ultimately I'm going to assess and admit the pt anyway.

sbostonRN · Feb 18, 2014

We don't receive a verbal report from the ER on new admissions. The ER enters a "handoff" in the computer which I honestly receive very little information from. But it does list the nurse's name so if I have a question, I can call down and ask. The ER physician documentation is my primary resource for why the patient came in, and what interventions have been instituted since their arrival. We have electronic MAR so any meds that were given should be in there, and if I ever have any uncertainty, I just call them and ask.

ParalyticAgent · Feb 18, 2014

Lots of hostility towards the ED. We're all on the same team.

In my ED, we have 30 minutes from the time the provider puts in the admission order to: get a bed, call report, and get that patient to their inpatient bed. If we don't meet that mark, we need to explain why we didn't.

From my standpoint, it is nice to be able to give report uninterrupted, not be harassed over details that are not pertinent to the ED course of treatment (How does the chest pain patient ambulate? Ugh, an IV in the AC? Does the admitting doctor know about the white count?), answer any questions, and get the patient out of the ED to the inpatient setting.

I am not trying to get out of work by getting the patient to the floor. It is likely that by the time I return from the floor, a new patient will be waiting in the room already. A new patient is far more work than a patient who has been worked up and has a dispo.

I realize I'm not going to change anyone's minds here. Everything I've said has already been said before.

jallen326 · Feb 19, 2014

I share your sentiments but I think if we got to see both worlds we will have a better understanding and hopefully improve the flow for the patients admitted from the ED!

suanna · Feb 19, 2014

I can see a printed report. Verbal reports from the E.R. usually went something like " the patient is fine as far as I know- I just picked them up to call report and they look fine from here..." At least with printed report, a format that answers the most pertinent issues is filled out by the nurse that knows the patient. If you have questions- you can always ask. It takes no longer for the floor to pick up the phone and call the ER with questions than it did for the ER to pick up the phone and call the floor with report. The difference is with a printed report, no one is on hold listening to the hospitals' current ad message for 20min while the receiving nurse is tied up in a room with an anxious patient and can't get away. If everything you want to know is on the report fax- no one has to waste time on the phone.

allnurses Guide · Feb 19, 2014

We do faxed report from the ER. I love it. Expedites things a great deal and keeps the stress of the ER from running over onto me (fewer editorial comments about the patient, their family, their history, etc). They fax up a filled in report sheet with all the pertinent info and the documentation of care given since arrival along with all the other stuff. It is plenty to go on and expedites things on both sides. If I have a question I can call down there, but I have only ever had to do that once, due to a difference in nurse assessment of LOC versus what the MD notes said. The nurse's were right (of course!).

AJJKRN · Feb 20, 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.

I'm just curious about if many other hospitals have their nurses/techs/everyone else carry assigned company phones on them at all times like mine does? Every floor that I work on at my hospital (I float) we are assigned a phone for that shift so NO hiding unless in an iso room or in the bathroom and then there's a way to the search missed calls on the phone to call back. We leave the phones when we clock out.

At times we have problems with verbal report being done (or not for that matter) between the floor and the ED too at my hospital but availability of the floor/ED nurses shouldn't be an issue because we all carry phones...

SubSippi · Feb 21, 2014

Our ED nurses never give report...a lot of them will get pretty snippy if they forget to document a medication was given, and we call them to clarify, because our two systems don't "talk" to each other (which I HATE). Some of them don't mind, I guess it just depends on the nurse. It used to irritate me, but I think it only irritated me because I felt like I should be getting a full verbal report each time I get a patient handed over from another nurse. It can be hard to coordinate a conversation between a floor nurse and an ED nurse, and I haven't ever had anything bad happen due to a lack of report.

The only thing that has made me MAD is when I had a patient come up on a heparin gtt, and someone just came and laid the papers down at the nursing station (everyone was with a patient), and just clamped the line. They were at the end of the hall, and I didn't even know I was getting a patient, so that patient sat there for about 45 minutes before I even saw her. Everything was fine though, it just worried me.

Oh, and AJJKRN: definitely no phones. I can't tell if that would be incredibly convenient, of awful.

sbostonRN · Feb 21, 2014

I'm actually very pleased with our system of written handoffs. No waiting on hold while waiting to give report. Let's face it: we're all busy and it's never a good time to sit down and get a report when a fax or written report/blurb will suffice. I do appreciate a verbal handoff when the pt requires special protocol like heparin drip or if they need to receive any stat meds.

HeartRN13 · Feb 21, 2014

Although all points are heard and valid the problem I have run into is that the Ed hold these patients for 2 plus days in the Ed. I work on a cardiac floor, but by the time the patient has gotten their cardizem bolus and been initiated and tirated off of the drip, this information isn't being communicated. Not only that, but where do we find how this patient tolerated it or didn't, did their bp plummet? Is that why it's stopped? There are no progress notes in the facility, no communication lines between nurses for transfers, and no continuity of care by the time they get to our floor. Frankly if it works at a facility they have organization on all levels, kudos to you. But where I am speaking of, it's chaos wall to wall, corner to corner, unit to unit, and I would never work in this hospital without carrying my own private Liability Insurance. It's SCARY