ER handoff report to floor

Editorial Team / Moderator · Oct 2, 2010

Our process is similar, except that we record a verbal report to a phone system. The receiving nurse is notified by the house supervisor or team leader when report is in the system, and the team leader ensures the receiving nurse is able to listen to report when it's in. We also print a copy of the report to the floor's printer at the time that the patient is being transported there, and sometimes there is a difference of an hour or more between the time that report is called and when the pt hits the floor, for two reasons: a) our ED is located a distance away from our main hospital and admissions are sent by transport company ambulance, and b) we call report to our "hold bed" number in the ED the minute we have admission orders, and the report is flipped into the receiving bed by the supervisor when she assigns the bed (which doesn't always happen right away).

The receiving nurses, once they listen to report, will call us if they have questions. If they don't have questions, they don't call. It used to make me a bit uncomfortable to not speak to a human when we implemented this system, but it's been working well, for the most part. Sometimes the floor will call to let us know they've listened to report, and to see if there are any changes since report was called. But usually I don't hear anything.

Sounds like the process needs addressing at your facility.

Daliadreamer · Oct 2, 2010

When I first started at my current hospital earilier this year, we would receive notice from the nursing supervisor that we would be getting an ER patient. Then the ER nurse would call JUST to get the last name of the floor nurse that would be receiving this patient so that they could place the last name in the hand off tool in the computer, which would look like they had given report to the floor nurse. Then ER would send the patient up. NO report given, NO speaking with the floor nurse, NO report sheet. It was our responsibility to find out information in the computer system about this patient.

When I first started here, I was like, what? The ER nurse gets to have my last name and state in her report that I was told all of this information, when in reality, the secretary was just giving my last name to the ER nurse and that was that. It was so unsafe.

Just recently, the policy changed, thank God, and ER nurses now must give report. MUCH better. I don't understand the people that make up these silly policies when it can't possible be good for the patient.

Propranolol · Oct 2, 2010

We typically get verbal report. recently i've seen the ER just sending a faxed report. the pt comes to the floor and we scratch our heads. rooms not ready. patients need to be moved. its embarrassing when the pt has family members who are AAO and look visibly upset. the hospital doesn't look good. Sometimes the reports are half correct. in medicine/nursing, communication is the basic foundation for proper patient care. period. sometimes the ER just wants to bounce the patient out of their area, ASAP (annoying family), for whatever reason. this happens in other departments too, not just the ER. unacceptable. PERIOD. -good day.

Penelope_Pitstop, BSN, RN · Oct 2, 2010

We receive faxed report, and about half of the time the nurse who faxed the report will call to make sure it arrived.

At the bottom of the report sheet, we're to "call so and so with any questions."

ICU nurses receive telephone, and stepdown nurses might as well, not sure.

Do I like it? No, but that's how it's done here, and I'm used to it.

nursej22, MSN, RN · Oct 2, 2010

We tried a written report using a form crafted by one of our nurses and an ED nurse. We tried several versions, but have abandoned it and gone back to phoned report. Problems with the written report:

Once the report was sent, a phone call was supposed to be made by ED to make sure report had arrived and were there any questions. But sometimes the patient would arrive but the receiving nurse hadn't gotten report or a phone call yet.

The written report was incomplete, illegible, or just plain incorrect.

The report would have a phone number for the ED nurse for questions, but (s)he was never available (their same complaint with us).

There would be no name on the report, and it's not unusual for us to get 3 patients at once.

Not to sidetrack the thread, but the floor nurses sometimes have more info than the ED RN, via the EMR. We can access labs, imaging results, meds pulled from PYXIS, and sometimes if they are in ED long enough, we can read the admission H&P, as well as old records.

This is not too bash the ED staff. I know they are freaking busy. IMHO, they could use more staff, a different care delivery system or something. I can't even imagine caring for the mix of psych, trauma, acutely ill, and hangnail issues they do, day in and day out.

NocturneRN · Oct 2, 2010

I've been on both sides of the issue at my present hospital (used to work on tele, now in ER), so I've seen the problems with each of the many approaches we've tried. When we used a telephone report, we seemed to end up playing phone tag. And, when we used a written report, it left the receiving nurse unprepared. (Another problem I noticed is that ER nurses tend to be unaware of just how busy floor nurses are, and floor nurses seldom realize that ER nurses are under pressure from management to move patients out quickly. One of those "customer satisfaction" issues.)

The system we're using now isn't perfect, but it seems to work better than anything else we've done. As soon as a bed assignment is obtained, the ER nurse fills out a computer form that includes basic information (vitals, IV status and orders, medications that need to be given, what was done in ER and so on), and any pertinent information that might be helpful, such as disabilities, patient concerns, and if the admitting doctor and/or any consults need to be notified.)

The report is then transmitted to the receiving unit, and the charge nurse is called and informed that it's been sent. It is his/her responsibilitiy to assign the patient, and the receiving nurse's responsibility, once aware that report has been filed, to read it and make sure the room is ready.

We then give the floor 20 minutes (unless they can take the patient sooner, or unless there's some special problem---e.g., an unstable patient, or they have to call in another nurse----requiring extra time.) During those 20 minutes, the receiving nurse can call down with questions or concerns. (They seldom have to do this, because we try to give them a thorough report through the computer----it saves us all time in the end!)

We've been using this method for over a year, and I've heard very few complaints from either side. It seems to work quite well, and patients are able to get off those awful carts and into a more comfortable bed in a timely manner.

(I should add that we're still doing critical care report the old-fashioned way----by phone.

nurse2033, MSN, RN · Oct 2, 2010

Yeah, sounds sketchy. We do a verbal report only. A written report usually can't cover all the nuances and information given in a verbal report. Please keep track of the delays and problems and present them to your manager. If you could get a quorum of nurses to back you up, maybe you get effect a change, especially if you can come up with some alternatives.

caroladybelle, BSN, RN · Oct 2, 2010

Correct me if I'm wrong, but don't current regs (JCAHO, etc.) now have that mandate that nurses giving and receiving pts have some opportunity to verbally/face to face discuss the pt and ask/answer questions?

I will be honest and say that on the typical medsurg/oncology floor, I have rarely had an adequate or apprpriate report and the few times that I have gotten verbal report or asked questions, the answer to many basic questions is "I don't know". In many places, the ER charge gives report, or an associate that has barely even seen the pt. And as such, the report is flawed and not even adequate.

If, on the average medsurg floor, the nurse is covering 5-10 other pts, and has 2-3 DCs or admits in a shift, this can be quite dangerous.

In my current position, I have better ratios, fewer admits, DCs and the unit has CC capability - thus easier to handle these issues. Even so, the ER knows that they must give an adequate report.

VICEDRN, BSN, RN · Oct 2, 2010

In my facility, we use a fax report. Er nurses call to confirm that the unit received the report. We then give a few minutes to the floor to prepare themselves and then bring the patient up.

I work in the ER so I have a few things to say to the OP:

I don't make bed assignments. The admitting physician does. Please take your complaints up with them if you have to RR a new admit. I don't always agree with the assignments either.

I am sure that you are not surprised that the transfer process can cause a change in vitals or incontinence.

I hate the report game. I have called to confirm receipt of my fax only to be asked if I could just "hold off" a bit longer or could I please just call back in ten minutes as the room is not clean. (only to find out that the nurse has purposely asked the housekeeper to clean other rooms first) A half an hour later and the charge nurse is asking me how come I haven't moved my patient yet (and thinking I am lazy).

We give verbal report to ICU and I am so tired of being refused. I hope I never work at a place that insists on verbal report. The ICU refuses almost every single time and it turns into a game. "Oh! nurse is in a patient's room" or "let her call you back in two minutes" and 30 minutes later...

For the record, if the standard of care requires that the hand off is nurse to nurse, you can meet me in your patient's room in ten minutes. By the time I am done settling them in, I should be on your floor for a total of 20 minutes or so. I also don't like leaving them alone but I don't own whether you are there or not when the patient gets there.

You probably received ample warning from the secretary, charge and house supervisor. You probably already knew that you would get an admit to that bed so why is it such a surprise when I call to tell you I am coming up?

Also, please note: I don't order consults. The doctor does.

As for the report sheet, I can't address things that the physician hasn't prescribed for and I won't initiate any orders if I am told there is a bed for this patient. In fact, I can't. I have a timer that tells me I must transfer the patient within a certain number of minutes.

BrnEyedGirl, BSN, MSN, RN, APRN · Oct 3, 2010

I have also been on both sides of this issue. I spent 3 years in ICU, 8 yrs on Cardiac floor, the last 3 years in ER. Let me start by saying I'm not going to criticize either group of nurses here. I honestly believe that most ER nurses have no idea what goes on on the floor and most floor nurses have no idea what goes on in the ER.

When I first transfered to a cardiac telemetry floor it drove me crazy to find that yes my pts are on telemetry, but you could only see it at the nurses desk and you only got a rhythm strip and a heart rate, no BP, no SPO2, nothing else and your pt may be 10 doors away from the nurses desk! I quickly learned that I wasn't receiving pts that were that critical.

On the tele floor if a pt began having chest pain, we got placed them on O2, got an EKG, gave and asa and three nitro and called the doc. Was I capable of starting a nitro gtt,..sure,.but I had sometimes 8 or 9 other pts to care for and couldn't possibly monitor a pt on a nitro gtt! My floor had way different protocols than ICU,..and for good reason.

When I moved to ER it was a whole new ball game. I suddenly had almost no limits on meds I had on hand and was allowed to give,..and I had a doc right there to order what was needed. I never got report on pts,.they just show up! It was a very different atmosphere to work in.

I was recently placed on a committee to address hand off issues with the floor. We were having many of the same concerns you mentioned in your OP. We now call report, then call as we are leaving the ER. We must wait at bedside for the RN to come into the room and wait for the first set of VS. We take a print out of the pts ER chart and record time we arrived at the room, time accepting RN arrived, and the VS. The floor keeps a copy and we keep a copy. Honestly this makes me feel like a 3rd grader,..but it has stopped a lot of the "she didn't tell me that in report" complaints.

I get so very frustrated when I hear my co workers make statements like "the nurse on 3 west is refusing this pt,.she says he isn't appropriate for her floor,..isn't she a real nurse? We took care of him for the last three hours now it's her turn. Doesn't she realize we are crazy busy down here!" Well,..yes but don't you realize that Nitro gtts aren't allowed on her floor,..or that GI bleed with a BP of 90/60 will probably go south on her and she doesn't have the time or the staff to get VS Q 15 min to even notice when it happens! Then of course, when it does happen the pt will be transfered to a unit bed, and turn over of beds on the floor is way more time consuming and complicated than moving from ER to the floor!

I am often ashamed of the behavior of my co workers both in ER and through out the hospital for making the assumption that someone is trying to get out of work, or that somehow they are the only nurse in the hospital that is running their butt off! Get over yourselves folks. We have rules and protocols for a reason, to give the pt the best care we can.

I'll step off my soap box.

GM2RN · Oct 3, 2010

We are allowed to fax report for patients going to M/S, everyone else must get a verbal report.