ER nurses not calling report anymore...

[plinytheRN]

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.

[Altra, BSN, RN]

It still comes off as a threat since its not normal to send a patient up without calling, and the receiving nurse wouldn't like getting the patient without report.

The "threat" is likely the result of prior unsuccessful attempts to streamline the movement of admitted patients out of the ED. ED throughput is now a core measure with financial impact -- and as such it is now a whole-hospital problem, not just an ED problem.

[MunoRN, RN]

JC is a de facto regulatory agency, as accreditation is required for Medicare/Medicaid reimbursement as per CMS.

I'm just relaying information to readers that nonverbal reports have not incurred citations from JCAHO, nor our state DOH. I'm using the general term "citations" to broadly include all negatively noted variances from standards. And I'm referring to post-2006 practices where I have worked.

I think you're referring to National Patient Safety Standards rather than Goals. Facilities must meet or have a plan for meeting all Standards, while NPS Goals are initiatives that are still in the process of becoming Standards.

Either way it's arguably safer practice than a non-interactive report.

[MunoRN, RN]

The "threat" is likely the result of prior unsuccessful attempts to streamline the movement of admitted patients out of the ED. ED throughput is now a core measure with financial impact -- and as such it is now a whole-hospital problem, not just an ED problem.

The ED core measures sets a goal of 4 hours between admit orders and transfer, I don't think a 5 minute report is delaying people more than 4 hours.

I do agree that floor Nurses are often at fault for delaying report and transfer. There are no situations where a Nurse shouldn't be getting report within 15 minutes of transfer orders.

Prior to patients going to the floor we do notify the charge but we do not give report. There is a hand-off report generated by the EMR which contains the pertinent information regarding c/c, diagnosis, lab values, meds, vitals, ambulatory status, etc.

Patients heading to the floor are stable (of course, sometimes conditions change but those are the outliers) or they'd either stay in the ED or go to the ICU.

We're JC accredited...

[withasmilelpn]

Have been through numerous surveys through 17 years of Nursing and 6 as a CNA, by JCAHO, CHAP, ACHC, CARF-CCAC, PA dept of Health...numerous ABC regulatory agencies depending on what nursing job I had at the time. I can say with confidence that what you're facility is cited on depends totally on WHO your surveyer is. They all have their focus, personal pet peeves, agendas and latest fad or (obsession.) Interpretation of the rules, and whether they unearth a problem at all during their investigation also comes into play. (They have to find it first!)

What will be a problem one year may not be even be on their radar the following year ( assuming you met their plan of correction requires if needed of course.)

If JACHO's (or whoever) regs state report should be interactive and another facility has been found in violation of it - 'abandonment' - eek !- your facility would be wise to reconsider this policy. It may not be a problem now, but it certainly may be at some point in time.

[sissiesmama, ASN, RN]

Wow! My coworkers would have a field day if we didn't call report. Dh and I live in Louisiana too. I ought have to read up. Thanks OP - glad to hear from a fellow La nurse.

Anne, RNC

[imintrouble, BSN, RN]

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.

[Beverage]

Out hospital did a trial of faxing SBAR report to the floor in lieu of verbal report, it was a failure and we have since gone back to phoned report. I had several near disasters from faxed report, pt with BG in the 400's for 2 hours had not received any insulin (DKA), SBP 80's which I was able to see in the VS portion of the EHR, and SBP 200+. I think these examples are the few patients I refused to assume care for until they were stabilized, medicated or bolused/dopamine gtt started.

[caddywompus]

Some things all floor nurses need to know about the ER-

First thing-

Sometimes we have to call report without seeing the pt. I can't count the number of times I've had a chart shoved at me from a charge nurse as they were saying, "Call report on xyz, we've got 4 trucks coming." It's not ideal, but sometimes we don't have a choice. We have to empty rooms and move patients as quickly as possible. Also, sometimes we give report on another nurse's patient. When I have to give report on a patient that I haven't seen, I always tell the nurse right away. Some are understanding, and some don't have a clue of what's going on in the ER.

The second thing- most ER nurses have worked the floor. We know you are busy too. We are not trying to screw over the floor nurses in any way, nor are we lazy. Our assessments are different. We do not do head to toe assessments. Coming from Med-Surg to the ER, this was a hard habit to break. Our assessments are focused to only the chief complaint. For example, an abdominal pain patient won't get a neuro assessment as well, unless something obvious is going on.

IV's.... When I was on the floor, I used to complain about IV's in the AC. Now that I work in the ER I understand why so many are there. An example- A patient with an elevated D dimer needs a chest CT. Radiology needs at least a 20ga in the AC or higher. The floor nurse is upset because this AC IV will make the pump go off all the time. We get it.

I went a little off topic there. It is frustrating for ER nurses because it is the rest of the hospital against us, and every floor has its assumptions about what we do/don't do. Coming from the floor to ER was EYE-OPENING to say the least. It is a different world.

[GM2RN]

Not every pt being admitted needs an IV, or sometimes, as good as we are, we still can't get access. Granted this should be communicated to the floor nurses somehow

Policy at my hospital is that every admitted pt must have IV access, even if the only access that can be gotten is a 24g in a thumb or foot.

[Esme12, ASN, BSN, RN]

I can understand how that change in policy could be frustrating for you, and I am an ER nurse. While the ER may not have to call report, if you are looking in the computer and seeing labs/assessments/etc that raises questions or red flags then you could always take the initiative to call the ER and ask for report.

I'm an ER nurse and a ER manager.....I think the burden of report is on the nurse who has been caring for the patient. Most mistakes/lawsuits are over misinformation during handoff report.

OP how is your facility fulfilling The JC National Safety patient goals http://www.jointcommission.org/center_transforming_healthcare_tst_hoc/

An estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off. In addition to patient harm, defective hand-offs can lead to delays in treatment, inappropriate treatment, and increased length of stay in the hospital.Ineffective hand-off communication is recognized as a critical patient safety problem in health care. The "hand-off" process involves "senders," the caregivers transmitting patient information and releasing the care of that patient to the next clinician, and "receivers," the caregivers who accept the patient information and care of that patient.

and the AHRQ recommendations for best practice. (The Agency for Healthcare Research and Quality (AHRQ) is the lead Federal agency charged with improving the quality, safety, efficiency, and effectiveness of health care for all Americans.)....AHRQ Patient Safety Network - Handoffs and Signouts

Handoffs and signouts have been linked to adverse clinical events in settings ranging from the emergency department to the intensive care unit. One study found that being cared for by a covering resident was a risk factor for preventable adverse events; more recently, communication failures between providers have been found to be a leading cause of preventable error in studies of closed malpractice claims affecting emergency physicians and trainees. The seemingly straightforward act of communicating an accurate medication list is a well-recognized source of error. To avert this problem, hospitals are required to "reconcile" medications across the continuum of care. (For more information, see the related Primer "Medication Reconciliation.")

[Altra, BSN, RN]

As I've said earlier in this thread, Esme ... the process can pass muster with surveyors from JC and the state DOH, so apparently they are not interpreting the NPSG in the same way that you expected.