ER nurses not calling report anymore...

Nurses Safety

Published

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.

Specializes in Critical Care.
I'm really struggling to understand... how is the EMR hand-off report *not* communicating?

The theme here seems to be that if it's not done by voice then communication is not happening.

For that matter, why are people so attached to *hearing* somebody *tell* them lab values when that process will NEVER be 100% accurate while the chart *is* accurate (or at least what the docs are basing their decisions on.)

IMO, having been on both sides of the floor-vs-ED divide, as well as taking on pt assignments for lunch breaks, etc... the only thing that's particularly important to specifically communicate would be (a) potentially violent/volatile patients and (b) high-fall-risk patients who've been trying to climb out of bed. Everything else is - or should be - immediately and quickly visible in the chart.

That said, I've used some atrocious EMRs (cough-next-cough-gen) in which information is so difficult to retrieve that they're all but useless for a nurse.

Regardless, the chart is where the actual information resides and anything the nurse says in report is an approximation thereof whose accuracy and completeness cannot be 100% presumed.

There's two parts to any effective report; the data and the story. The EMR provides the data, the interactive report provides the story. If all that needed to happen in the ED was data collection to pass on that data there would be little need for RN's, it's the RN, and the story they formulate, that takes that data and makes it mean something to the next Nurse.

Communication is sort of the topic du jour these days, so if you're wondering why interactive communication is important there googlable sources from the Joint Commission, IHI, AHRQ, CMS, and usually your state's BON as well.

We recently switched to a "better" ED charting system, although the "report" it produces still reads like MS-DOS programming, and it's worth noting that none of the "report"s produced by these EMRs were intended to be a stand-alone report, they are intended to facilitate report so that the data is easily accessible to both parties so that they can just focus on the story part of report.

Specializes in PCCN.

you know,I hate to say it,but where I am , sometimes reading the chart (emr) gives me a better report than the actual called up report.

Specializes in Emergency Room, Trauma ICU.
No insecurity issues here. I've just seen more than my share of lazy and/or inconsiderate ED nurses who will do whatever it takes to empty their rooms by the end of their shift.

And we've all dealt with lazy floor nurses who can't be bothered to take report, or lie about the room being clean and other shenanigans. Do you honestly think it's about having empty beds in the ED? It's about getting the admitted pt out so the one waiting in the hall, waiting room or ambulance can be moved into the room. Try spending a shift in the ER and you'll understand. We don't get to say no to a pt, we HAVE to take whatever rolls in.

Specializes in Pain, critical care, administration, med.

I think the perception of nurses is we often think that each other is lazy. I do think walking in each others shoes may put perspective on the others plight. Yes the ED has one door, the ICU has many doors and the floors has doors but those are due to admissions and then sending patients to other places for tests. Report needs to be given it is a safety measure. We have a process that admissions from the ED to the unit is done in less than 45 minutes once a bed is assigned. There are barriers but it happens. We also have nurses that are present 7am 11pm to do the admission.

As a critical care nurse who is now a director if a med surg unit each area has there own unique issues we all strive to give good care but need to respect each other without our individual preconceived ideas.

Because communication is a two-way street. Not only does information have to be given, it has also to be received and understood.
Sure... which is why they can call if their are any real questions after they've eyeballed the patient.
There are things that will make the nurses day much smoother such as issues with the family or particular issues with the patient that are not necessarily in the emr.
There can be... but that is the fairly rare exception in my experience and making things "smoother" isn't necessarily a priority.
Just reading the emr doesn't allow the receiving nurse to ask for clarification of anything such as we're supplements given or which of the three abx were started.
Really? The MAR, not to mention the bag of abx hanging on the pole, should be perfectly clear about that.

If, after a few minutes with the patient and the chart, questions remain, the floor nurse can call... and they do sometimes... but very, very rarely... usually, they just assess their patients, do a quick review of the chart, and move on.

There's two parts to any effective report; the data and the story. The EMR provides the data, the interactive report provides the story.
Fluffy, IMO. The "story" is just not that important, IMO.
If all that needed to happen in the ED was data collection to pass on that data there would be little need for RN's, it's the RN, and the story they formulate, that takes that data and makes it mean something to the next Nurse.
The next nurse is perfectly capable of making their own 'story.' The role of the ED nurse is rapid-fire "assess, plan, intervene" over and over... not creating stories about their patients.

Communication is sort of the topic du jour these days, so if you're wondering why interactive communication is important there googlable sources from the Joint Commission, IHI, AHRQ, CMS, and usually your state's BON as well.
Yep, I've read quite a bit on the topic... and still maintain that it's the very rare case where a m/s or stable tele patient requires voice report.

We do not do voice report on floor patients and it works just fine... it's certainly much more efficient in getting patients moved along their path.

I've been a m/s nurse - and still pull shifts in our holding pen... I've seen that side and I still firmly believe that verbal report is largely a waste of time...

Specializes in Neuro ICU and Med Surg.
Not so. I've worked in a hospital where report on a non-ICU patient consisted of just the electronic documentation from the ED -- no Joint Commission problems.

This is what our hospital does now. Just used ED documentation, and not really the best way to get report when they don't sign out the chart so the floors can look at it before the pt gets there. I am not assigned to a unit since I am rapid response, but I see the floors frustration at the lack of report. Sometimes even patients being placed in inappropriate units as well.

Specializes in Critical Care.
Fluffy IMO. The "story" is just not that important, IMO. [/quote']

I use the term "story: hesitantly as it does sound a little fluffy, but what I'm referring to isn't fluffy. What "story" refers to is the level of understanding of a patient that is partly based on, but goes well beyond the data. Formulating and implementing this understanding is part of every state's Nurse Practice Act for RN's. If you're just gathering data, processing orders, following "if this then that" orders, etc then you're really just a highly paid ED tech.

The "story" is also how we communicate the items that don't fit well into fill-in-the-blank written reports and we know from numerous incidents that injuries and often death occurs without the information that is more consistently communicated outside of a data-based report. For instance, we had a short-lived trial of a faxed report for ED admits. A patient came in with chest pain, per protocol the patient was about to be given NTG when an alert box popped up for the Nurse warning her not to give the NTG as the patient was on Remodulin. Remodulin was new at the time and it's NTG contraindication was not common knowledge. She filled out the report form completely but was unaware that the inpatient EMR had not yet been loaded with alert pop-up, the patient was given NTG, coded and died. In talking to the Nurse, the remodulin near miss was the clearly the most prominent thing she remembered about the patient, and undoubtedly would have been a topic in a verbal report.

I don't like to be melodramatic, but would you really be willing to explain to her husband and two little girls that a report format that likely would have prevented her death "is just not that important"?

Yep I've read quite a bit on the topic... and still maintain that it's the very rare case where a m/s or stable tele patient requires voice report.[/quote']

So despite universal agreement from IHI, AHRQ, CMS, the JC, and pretty much every patient safety initiative in the last 5 years, they are all wrong because...? They all have long lists of adverse events that could have been easily avoided with a better report, often where just including a verbal component would have made all the difference. All they are trying to do is keep us from making the same mistakes over and over and over again, that seems pretty reasonable.

We do not do voice report on floor patients and it works just fine... it's certainly much more efficient in getting patients moved along their path.

I hope we can agree that efficiency isn't our only goal. Our goal should be efficiency without excessive compromise of safe or effective care.

Specializes in Critical Care.
Sure... which is why they can call if their are any real questions after they've eyeballed the patient.There can be... but that is the fairly rare exception in my experience and making things "smoother" isn't necessarily a priority.Really? The MAR, not to mention the bag of abx hanging on the pole, should be perfectly clear about that.

If, after a few minutes with the patient and the chart, questions remain, the floor nurse can call... and they do sometimes... but very, very rarely... usually, they just assess their patients, do a quick review of the chart, and move on.

There's a reason they call "very,very rarely", and that's the problem with the "call if you questions" kind of system. My state's BON doesn't allow this as a way to satisfy their "interactive" report requirement for two main reasons.

One is that ED Nurses don't hide the fact very well that they don't like being called with questions, they consider a waste of time, as you pointed out.

Also, many adverse events occurred due to failures of communication that the receiving would not have known to ask about, in many instances the Nurse wasn't given enough information to even know a question needed to be asked.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
No insecurity issues here. I've just seen more than my share of lazy and/or inconsiderate ED nurses who will do whatever it takes to empty their rooms by the end of their shift.

and I have seen plenty of lazy and/or inconsiderate floor nurses hide beds and avoid taking report on their patient in the ED to stall the admission.

As I was sending patients up last night I was mindful of this thread.

In each case, there was nothing to shake my firm belief that voice report would add nothing to what was clearly laid out in the EMR.

While efficiency is not the paramount goal, it is a very important goal and mandating a telephone call for each transfer is pointless; the vast majority of m/s and tele admits simply don't need it.

If, for some reason, things are unclear, the floor nurses have multiple options for clarification so it's not as though they're receiving a patient through a black hole.

I suppose that if the receiving nurses would actually glance through the chart before taking report, I might view it in a more positive light. As it is, they seem to want to be spoonfed and told something so that they can write it on some note instead of taking the onus on themselves to do a little research about their patient... ironic since that's how must of us began in nursing school... look at the chart before taking the patient.

I'm a professional nurse and if there's something important which needs to be communicated by phone, I'll do so. That is an extreme rarity, though.

Specializes in SICU/CVICU.
As I was sending patients up last night I was mindful of this thread.

In each case, there was nothing to shake my firm belief that voice report would add nothing to what was clearly laid out in the EMR.

While efficiency is not the paramount goal, it is a very important goal and mandating a telephone call for each transfer is pointless; the vast majority of m/s and tele admits simply don't need it.

If, for some reason, things are unclear, the floor nurses have multiple options for clarification so it's not as though they're receiving a patient through a black hole.

I suppose that if the receiving nurses would actually glance through the chart before taking report, I might view it in a more positive light. As it is, they seem to want to be spoonfed and told something so that they can write it on some note instead of taking the onus on themselves to do a little research about their patient... ironic since that's how must of us began in nursing school... look at the chart before taking the patient.

I'm a professional nurse and if there's something important which needs to be communicated by phone, I'll do so. That is an extreme rarity, though.

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?

+ Add a Comment