ER nurses not calling report anymore...

Nurses Safety

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Hey all, our hospital started a new policy where the ER nurses don't have to call report on the patients coming to our floor- they can choose if they want to call report. Most don't call report. It is up to us to find this patient and research all about them before they get to the floor, hopefully. Most of the time, they show up before we know they are coming. It is very frustrating and unsafe, we don't know anything about what we are walking into. I work on a medical telemetry unit, with usually 5-6 pts per nurse, it's hectic and busy no time to be clicking through a computer on a new admit. From what I understand this is a trial to test out this new policy, I am hoping it doesn't last. It seems the only one that benefits from this new policy are the ER nurses, it's definitely not ideal or safe for the patients... Anyone experienced this sort of thing? Thoughts? Thanks.

I have on very rare occasion sent a pt upstairs without a line, if the pt refused. It was documented and communicated to floor nurse. And of course I tried to reason with the pt

I have never had a patient refuse, but of course you can't force them.

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Specializes in Emergency Room, Trauma ICU.

I don't understand why the ER nurse is being harped on for "inappropriate admissions". The ER nurse has no control over what pt goes to which floor. If the floor nurse feels the pt is inappropriate then it's up to her or the charge to talk to the admitting doctor, not to take it out on the ER nurse who is just following orders.

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I believe that is true, but we have to have orders to not have any access on the floor at this hospital. I don't know all the details, maybe this pt was not very critical but from my position, I barely have time to get all I need to get done in time and starting IVs take up time. Appreciate your response. My real question is, why this change? what is the rationale behind it? Im ok with a walkie talkie, with no report, but otherwise I don't see it being beneficial to the patient or the nurse.

We went to this years ago, well sort of like this. We fax up report which is just a computer generated report of what was done, labs, that sort of thing. We are then REQUIRED to call and ensure someone has the report. This is typically the Charge nurse or unit clerk who will hand it to the nurse. We then give 15 minutes for the nurse to review then information and then we go up. The receiving nurse has the responsibility to call and ask questions. The main reason for this change was that we were having 15-20 patients sitting in the lobby waiting to be seen (some of which were quite sick) and we were having nurses say, "I am busy I cannot take report" or "That nurse is at lunch, try back later". This was unsafe for patients who were presenting to the ED and not getting to see a provider due to long admit to disposition times. Is it drastic? Maybe, but it is the only way to ensure patient flow. I realize you may think it is unsafe to not know anything about your patient but a doctor has completely worked that patient up, determined they are stable for your unit and handed them off to another doctor. If they were not stable they would go to ICU (which we call report to and not fax it). Think of the poor triage nurse whose license is riding on those 20 patients in the lobby who have not had a medical screening exam or any workup yet. That is unsafe. I truly see it from both sides and think there is likely a better fix but the most important thing is to get patients screened by doctors and the only way to do that is move patients out of beds. Hope this helps?

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At my facility, the nurse can absolutely call down and ask for report. However, we are under strict orders for our clinical supervisor to not answer any questions that are already charted. Meaning, "what kind history do they have?" Will get a, "I am sorry, that is in the faxed report you got, please see that." Now, if it something that we have not charted, that obviously should be answered. It actually creates better charting from the ER because we do not want to have to stop and answer 20 questions, just like I am sure you do not want to have to ask 20 questions.

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For the life of me I can't figure out the benefit of the ER not calling report.

The ER nurse might benefit, but then the floor nurse would fall behind trying to figure out basic, essential information.

ER calls report to the receiving nurse where I work.

I can't imagine it any other way.

I have only worked with a few EDM systems but I work with a pretty terrible one now and I can look up all the information I need (assuming the nurse charted properly which is a huge caveat) in less than two minutes. When our ER nurses arrive, we read our reports on the computer, then meet with the ongoing nurse to clarify any issues and usually there is none. The charge nurse on the floor should be telling the nurse who is getting the patient as soon as they know it is coming so they can begin looking for report. Also, it is really the best policy for the ED staff to alert the floor that they have arrived. Then, someone should come to the bedside and this is really the best way to ensure that report is given. I like everyone else hate change, I actually even hate that I do not call report anymore, but it is all part of where healthcare is going and in order to see the amount of patients in our ER, we must move patients quickly. Otherwise, people will keep dieing in our lobbies and I hate that more than anything.

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For the life of me I can't figure out the benefit of the ER not calling report.

The ER nurse might benefit, but then the floor nurse would fall behind trying to figure out basic, essential information.

ER calls report to the receiving nurse where I work.

I can't imagine it any other way.

This is one thing that drives ER nurses crazy. I call report all the time and am told, "The BP must be under 200 or I won't accept report." So we give them something and it goes to 180 and the patient goes up. I have never ever seen a patient have a CVA from an acute BP of 200, and nothing magical happens between 180 and 200. The ER MD's are usually aware of those BP's and do not like to treat them typically. The main reason is the therapy they choose and what the admitting doctor chooses may be different and changing meds for BP like that on a patient is unsafe. Likewise, a patient with a sugar that is high, likely lives that way and does not need emergent insulin (remember that is what emergency rooms are for, stablize emergent patients, not fix them. If we fix them then we do not need the floor.) unless of course they are being admitted for DKA. If they are being admitted for DKA, then there is NO reason they would not have been placed on a drip or been given a push.

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You say "empty a room" like it's some kind of completed task that has some benefit for the nurse. There will be another patient in that room within 10 minutes, possibly as little as 30 seconds after being "emptied". "Clearing your rooms" -- by coincidence discharging and/or sending all your patients who are admitted on their way within a short period of time happens sometimes, but guarantees 4-5 new patients within the next hour. Yes, read that again -- 4-5 new patients about whom you know nothing -- within an hour.

The important thing to remember is the patients the floor gets has all necessary workup (at least the emergent part) complete. When I get a new patient, even a lower acuity belly pain, they need an IV, blood work, meds, a vomit bag, a blanket, vitals, an assessment, and to go to Xray or CT. No one gives me any report on these people and at the time I meet this patient I do not know if she is having a triple A or a bad menstral cycle. Thats just something to keep in mind and it shows that we should all do a shift in each others units to see what the other does.

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Do you get any type of report from the triage nurse orprevious shift? When patients arrive via ambulance do you receive any type of report from the paramedics?

From triage? Absolutely not! NEVER! From EMS, if I am the nurse lucky enough to triage my own patient then yes. From the off going shift? No, we read our reports on the computer and then get with the nurse if needed to ensure we do not have nay questions.

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What sort of adverse events are required to buy 3 minutes of your time?

Absolutely none. It takes me that long to print out the information, go to the fax machine, fax it, and then call and ensure it made it up. At least half of the nurses upstairs were always great and made it a point to come to the phone when we called report. It is the few bad apples that would have us wait 5 minutes to come to the phone to say they had to call back. Then never would for an hour or so. It is one of those age old arguements that the good nurses are getting punished for the bad nurses but it is the best thing to get the patient to the floor. Just like the floor, the ER has bad nurses that will abuse this system too, we should try to work together and realize that we are all part of the solution and part of the problem.

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I imagine the patient with a CBG of 27 was acting funny? Does it matter if 1 unit of insulin or 100 units was given? Given the man d50, call your rapid response, or do what you have to do to treat the patient. We should be assessing our patients when they get to our units and thats how we catch these things. It didn't matter if they told you how many units they got, the patient still would have had the same outcome. And as far as no one knowing a patient was on the floor, again has nothing to do with report. The transferring nurse should have notified the primary or charge nurse, that is not excusable. Again, report would not have solved this problem, this is a problem with a nurse dropping a patient and running.

Just a scary update on this situation, ER sent up a patient with no report. They came in for hyperglycemia in addition to something else (not my patient). They came at a time when the BG didn't have to be checked, but the receiving nurse knew better, and assessment tipped her off, and found them to have a BG of 27. no insulin was charted, there was no way to know what they had been given except to call and ask, which isn't going to happen when you are dealing with a BG of 27... Frequently the ER does not chart meds they have given. Not to mention a sticky situation that happened the other night when a pt was sent up at shift change, no one knew they were there (not sure all the details) and they coded and died. Scary stuff. Such a lack of communication and patient care suffers.
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I am curious...honest question...how does your facility make this Ok for the JACHO hand off initiative?

This is now the standard. Hand off is not some magical thing that happens between two people. It is an exchange of information. Reading report on the computer is a hand off as long as the nurse has the chance to ask questions if needed. Presumably this would be at the bedside when the patient arrives but ER staff can never find a nurse to meet us at the bedside. We have been faxing report for years and only calling ICU or cath lab. Surgery comes get their own patients so they get a really nice bedside report. The floor patients are stable and everything is in the chart. No need for me to read it to them, if I know the information, I chart it.

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Specializes in Ortho.

GM2RN:

Any question is relevant. Asking who the admitting and consulting MDs is important, the computer is not always correct, isn't 2 seconds of a question better than finding out out a consult wasn't done because we were expecting the wrong MD.

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