ER handoff report to floor

[PatricksRNMommy]

In the past when receiving patients from the ER, they printed a report to the floor and then called to give a verbal report. Now the process has changed to improve pt flow. Now, the report is printed to the floor, the ER nurse calls the floor nurse to answer any questions. If the floor nurse happens to be busy taking care of one of her other patients and can't answer the call right away, the patient is sent to the floor, accompanied by a tech. Now don't flame me here, I am NOT in ANY way putting down ER nurses... I just feel like it's not safe to send a patient up to the floor without a real report... If the nurse has not received report, they have not really technically accepted the patient assignment, right? How can we safely accept a patient we know nothing about? How do we know a patient is safe to be on our floor if we don't kow anything about them. We can't stand by the printer waiting for a report to print when we have 4 or 5 other patients.

We have recently had several problems with this process, receiving patients with BP of 60/30 (report sheet said 110/70), sats of 78 (99 by report), laying in soiled sheets (continent per report sheet), barely breathing, markedly abnormal labs (also not on report sheet and never addressed), important consults not called (cardio for CP, neuro for CVA), STAT orders not initiated... Almost every day this week we have received a patient from ER and had to call the doctor or call a rapid response right away and send then to the unit. Which takes sometimes an hour or more away from our other patients... then the room gets cleaned and the process starts all over. I don't want to start anything here, I just feel like a verbal report SHOULD happen, even if just a brief reveiw of systems/abnormal labs with oppurtunity to ask questions...

What is the ER handoff process at your facility like? Does it work? And how is the relationship between the ER and the floors?

[shir977]

I'm sorry to "hijack" the thread, but I cannot PM yet and I would like to ask you a couple of questions about Sebastian hospital. Can you email me at [email protected]? I am originally from Vero and am ready to come home :-)

Thank You,

Heather

[gcupid]

I believe that all reports should be verbal no matter what unit. It allows the nurse to be prepared as well as gives the nurse who is actually taking care of the patient or admitting nurse the opportunity to ask questions. In addition to using this method, the receiving nurse has the opportunity to decide if he/she is willing to accept and resume care of the patient. There have been times when verbal reports have protected the patient from arriving to an inappropriate unit bc the nurse on the receiving unit knows what resources are available in regards to med supplies/equipment, monitoring, and staffing. Al7139, seeing as though we all got through nursing school by reading, you should know d*%#! well that reading report is not the issue for floor nurses. What does stop after becoming a nurse is the ability to NOT take full responsibility should an issue arise regarding an unsafe assignment after taking report. In the progression of being student to nurse, we should advance from just reading to being critical thinkers. Let's be treated like professionals.

[hodgieRN]

We started faxing reports a couple years ago. Phone reports take way too long. We still call report from the ICU to the floor. For me, I don't care what size the IV is. All I need to know is if he's got an IV. I hate it when you are interrupted with "wait, so the IV in the right arm is a 20G and the left arm is an 18G. Is the IV in the left arm in the AC or is it in the forearm?" It doesn't matter. Look at the pt when they get there. If a pt had back surgery 10 years ago, don't ask me who did it. It doesn't matter. If it's that important, look it up. Report ends up being 15 minutes long for a stable, routine admission.

There is no official way for calling report. Everyone is different. Some jump around, some follow the same routine. All I can say is don't interrupt me. If you have something quick here or there to ask, that's fine, but if I am talking about the neuro status, stop asking about the foley and or if they have accuchecks at that very moment. What meds do I have to give 4 hrs from now? Really...look at the MAR. (yes, happens all the time). Let me finish report and you can ask questions at the end if you need. If you can't remember what you wanted to ask at the end, it probably wasn't important in the first place.

I know the floors are busy. Everyone is busy. I think the more a person can write down during report, the less nurses actually have to read in the chart. If a very detailed report is given, that piece of paper is then used to give report at the end of shift. And I think that is lazy. My point is, when I get report, tell me the important stuff. I don't care about the IV size, or accuchecks, or what size the foley is...I am going to read the EMR anyway and get everything and more from the chart in order to give the best care. I hate getting asked what doctors are on the case. Read the chart. I'll tell you cardio is on case, but if want to interrupt me to ask what the name is, look it up.

Then there's nurses who have the need to tell you their own personal experiences with some disease process. This guy was on coumadin and he fell..."Oh yeah, you know my mother was on coumadin and she had a lot issues with it. One time we..." Wait, wait...that's great. Let's move on with report. I thought things were busy....

And the last thing that is frustrating with phone report is the nurse who has to write everything verbatim. This guy was admitted for intracranial hemorrhage. He is allergic to PCN. "Hold on, hold on..allergic...to...PCN. Intra...cran.....can you spell that for me?"

Faxing report is quicker and all the important info is on there. If there is something specific you need, look it up. If a nurse brings up a crashing pt or things are not done, then yes, there are things that should have been done before transfer. If someone has a low Hbg, then, yes, blood should at least be started. But so much time is wasted on useless nursing information. And at the end, we still have to transfer the pt, which always ends with nurses magically disappearing when the pt comes out of the elevator. I end up yanking the call light out of the wall so that light continuously goes off until someone shows up. Face to face is never gonna happen. Because that would mean I can just unplug the wires, immediately bring them up, and have the nurse waiting for me in to room for report. Yeah, that's never gonna happen.

[turnforthenurse, MSN, NP]

At my hospital, the ER nurse calls gives the floor nurse report via phone. There are no printed report sheets. The floor nurse should have the computer in front of them with the patient's chart opened so that they can clarify anything from the ER nurse's report. Usually our patients are stable enough to be transferred to the floor.

[Racer15, BSN, RN]

Currently, we call report and then send the chart up once the patient is transported. We are trying a new program out now where we fax everything, and then call the charge nurse before the patient is sent up. Seems to be working well.

[Sassy5d]

I thought of you all last night.

Calling report, the nurse tells me she's pulling up the chart to look at it while I talk. Then I talk and she tells me to slow down, she can't write that fast.

If you're looking at exactly what I'm looking at why do I need to slow down, especially when it's petty stuff like : he came in at 1140 today after drinking a bunch of hard liquor.

I keep it short and sweet anymore.

Alert? Oriented? Walks? Demeanor. Cooperative. Heart Rhythm, vitals, IV access. The end.

always end the call with the time I will be working until and please call with any questions.

[ADeks]

I have worked on a cardiac step-down unit and would receive patients on all kinds of gtts and in various states of chest pain. We do NOT get a verbal report. We get a page from our on-line system with the patient's name and ID number; 25% of the time the transporter will call to notify that they are bringing a patient up tot he floor. The idea is that all our charts are computerized so that we can look up all the information such as meds given, IV access, VS, Pain scores, and any notifications that the nurse/tech charted. When we DID get a call it was usually bad news.

Now, I am working in an ER at a different hospital in the area and we have the same computer system BUT we are to speak nurse to nurse. Now, I am told that only ICU patient's am I supposed to give a full report to. The rest, I'm supposed to call and basically give you the diagnosis and tell you the patient is coming up. Now, I COMPLETELY understand that most of the time, that floor nurse didn't know they were getting a patient. I also will tell you the abnormals and the most recent VS. I however do not want to to run through your whole Brain Sheet so that you can fill EVERYTHING in. I understand that at times I am sending a heavy patient to a tele unit, but for XYZ the MDs have decided that the patient does not require an ICU bed. This is, by all means, not because I let it go. I tell the doctor multiple times and sometimes they listen sometimes they don't. I also, have felt the repercussion of letting a floor nurse know that I am sending a very heavy patient to the floor and basically the patient is there 10 minutes and they call a rapid response in hopes to send this patient to an ICU bed. I have to say almost 80% of the time the patient stays on the same floor.

So what can you do? Also, we in the ER have EMTALA laws and we're supposed to send the patient up to the floor in 30 minutes from receiving a bed. So we get the push to rush our patients up to the floor asap.

[emtb2rn, BSN, RN, EMT-B]

EMTALA has nothing to do with how quickly you move from the er to the floor.

[Roosterread]

We have computerized charting, so the only time we give a verbal report is if the patient is going to ICU. If they are going to the OR, there is a quickie face to face with whoever picks the patient up, usually anesthesia. We get the orders, the charge nurse calls the supervisor and gets a bed assignment. The transporter picks up the patient and takes them to the floor. If the patient is going to a tele unit, there is a 15 min wait for the tele pack to be tubed to us. A nurse only accompanies the patient if there is blood hanging or if they are going to ICU.

[melonelle]

I work on peds and the ER nurses call report. I know the ER can be extremely busy. I get frustrated when they call report at change of shift. It usually means I have to stay longer to settle the pt.

[ADeks]

It's not always our fault. Usually at shift change there seems to be more beds available.

[RNFiona]

Every single shift on the floor is like a day getting slammed in the ER? Really? For many reasons I have to disagree. Both are tough for very different reasons. Kudos to all nurses :)

I laughed out loud when I read this.