Faxed Reports- Does it decrease length of stays in the ED

nuangel1, BSN, RN · Apr 12, 2007

we too fax report to floor.the hospital made a standard form with pt name rn name dx pmh hpi what med treatment given ,iv etc .the pertinent information last vs and time .we then fax reort once bed is assigned .the floor has 15 min .we call them at 15 min to verify fax was received and ask if the floor nurse has questions.most times not though if they do they get on phone aand we answer them .then pt goes up.occassionally floor will ask for few min if er is not busy fine if it pt goes up.we are not supposed to get room number till bed is clean and available.but occassionally we do get a room number but supervisor will say it will be ready in x time.like if pt is on precautions and there making a room.for ex.it goes fairly well .at least we are not playing phone tag all the time.

AirforceRN, RN · Apr 12, 2007

We've just started a new thing in the ED...

1)Dr. Admits Pt.

2)Unit clerk calls admitting and gets the binder in order

3)Floor calls and says "Mr. X will be in bed 555" (Can be hours before this happens depending on how busy they are)

4)ED faxes report and writes down the time

5)Patient is entered into transport system 90minutes later. This allows 1.5hrs for the floor nurse to read the report and call if there are questions. If the patient is in very heavy care or something interesting then we will call and give a verbal as a heads up. Its new but seems to wrok so far.

teeituptom, BSN, RN · Apr 13, 2007

We've just started a new thing in the ED...
1)Dr. Admits Pt.
2)Unit clerk calls admitting and gets the binder in order
3)Floor calls and says "Mr. X will be in bed 555" (Can be hours before this happens depending on how busy they are)
4)ED faxes report and writes down the time
5)Patient is entered into transport system 90minutes later. This allows 1.5hrs for the floor nurse to read the report and call if there are questions. If the patient is in very heavy care or something interesting then we will call and give a verbal as a heads up. Its new but seems to wrok so far.

"Can be hours before this happens depending on how busy they are" this is totally unacceptable in any form.

"This allows 1.5 hours for the floor nurse to read the report and call if there are questions" This is also totally unacceptable.

You have possibly hours before you get a bed assignment then 1.5 hours for the nurse to read the report. That means for hours your pt is just down in the ER occupying a stretcher, when they should be up in a room and a real bed.

You really need to streamline your system. Suggestion, set up an admissions unit, Where admitted ER pts go to awaiting admit. Helps quite a bit,

DusktilDawn · Apr 13, 2007

We implemented it to circumvent the floor nurse, who is busy, from answering her phone during her dressing change, and the charge nurse, who is busy fixing everyones "issues"
Why address real problems when we can be impersonal, and fax report...
Leave it to nurses (yes I am proudly a nurse) to deal with real issues indirectly...
Faxing report leads to:
1) omission of important information
2) further separation between the ER and floors
3) continued lack of growth in our profession

Absolutely agree. Pts often arrive on our unit unexpected. Often with report not having been faxed, or fax arriving after the patient if at all. What comprises a faxed report is worthless (that is if you can read it) for instance: elevated BP reading on page 2 and on page 5 you may find what antihypertensive was given and than refer back to page 2 to see what response the pt had to antihypertensive administered (possibly, it's actually more of an assumption). NO ONE EVER CALLS TO CONFIRM IF REPORT WAS RECEIVED. Absolutely no contact number if you have any questions, good luck if you get a hold of ER charge and they can even put you in touch with the person who took care of the patient (they've probably already left since most of our admissions arrive at shift change, even when we've had empty beds all shift). Reports need to be organized in a way so that needed information is complete, accurate, and as concise as possible. Reports not arriving, sent to the wrong place, technical problems with the fax machines (resulting in illegible reports or reports not arriving), no confirmation of reception, no notification of admission, no opportunity to clarify or ask questions regarding the report, lack of accountability on the transferring nurse's part. These are all issues I have with how faxed reports are handled.

Legally a report should contain information regarding the patient's diagnosis/surgery, treatment provided, and reaction to treatment, existing conditions, etc. It should also allow the receiving nurse to be able to seek clarifications and obtain additional information before doing a nursing assessment and initiating care. Irregardless of whether report is verbal, telephone, or written/faxed, the report must be incorporated into the medical record. If the transferred patient suffers some injury or dies after the transfer takes place, all those involved in the patient's care, including the transferring nurse and the nurse to whom the patient was transferred, would more than likely be named in the suit, especially if the documentation concerning the transfer, and what was done after the patient arrived on the unit, is legally insufficient or non-existent.

AirforceRN, RN · Apr 13, 2007

"
You have possibly hours before you get a bed assignment then 1.5 hours for the nurse to read the report. That means for hours your pt is just down in the ER occupying a stretcher, when they should be up in a room and a real bed.
You really need to streamline your system. Suggestion, set up an admissions unit, Where admitted ER pts go to awaiting admit. Helps quite a bit,

Funny, I just assumed this was the norm. Patients waiting for hours in the emerg is not unusual. Here we have 9 monitored beds, 9 unmonitored beds, 4 acute (resus) beds, 3 triage beds and an overflow area that can take 4 or 5 patients. Usually if a patient is admitted they are moved to an unmonitored bed (if possible) and can wait there for quite a while, I have seen more than 24 hours. I don't see a solution though, upstairs all the beds are full, the floors are over census and pts are having to be put in the hall. The hospital is only so big...

EMSnut45, BSN, RN, EMT-P · Apr 14, 2007

Our ER faxes report, but it doesn't seem to do any good. We always get the "I can't read it, what does it say," "I'm not going to accept the patient until you complete ____ order," "I'm too busy right now, I'll call you back when I'm ready...." and two hours later the patient isn't any closer to going upstairs.

It's nothing for me to come to work on the weekends and have 13 boarding patients occupying our 15-bed ER!! Administration is SOOO reluctant to go on EMS diversion because they will lose too much money. The end result is burnt-out employees and frustrated, unsatisfied, uncared for patients.

chip193 · Apr 14, 2007

I work at 3 hospitals...

#1 - my FT job - we attempt to call report once. If the nurse is unable to take report, we fax it and send the patient (so long as it is a ready bed). It has elminiated the game that was being played here where report would get pushed off for hours (after meal, to the next shift, etc.).

#2 - first agency (PD) hospital - we play phone tag for hours at times with the floors. They do not allow faxed reports.

#3 - second agency (PD) hosptial - we call report and open the computer record at the same time. Usually, if the primary nurse cannot take report, the charge will.

Three hospitals - three different methods!

Chip

mamalle · Apr 14, 2007

we have tried it over the years. they always go back to telephone report. I think if their was a better system it would cut down the waiting time. BUT at the same time most of our issues are due to no beds: ie no staff or full. I left last night at 7pm holding 7 tele patients in the ER. just the start of the weekend. I had to thank my lucky stars I wasnt scheduled to come back this weekend..

hollysunshine · Apr 16, 2007

We use Meditech for documentation and the program generates a report. When we get a bed assignment, we call the nurse to let her/him know that report is in the computer. This gives them an opportunity to review and ask question. The pt is transported 15 minutes after the nurse is notified. It has expedited the transfer process. Unfortunately, our main problem is being able to get a bed assignment and we often board 8-10 pts in a 21 bed ED for an entire shift. Very frustrating.

teeituptom, BSN, RN · Apr 17, 2007

Funny, I just assumed this was the norm. Patients waiting for hours in the emerg is not unusual. Here we have 9 monitored beds, 9 unmonitored beds, 4 acute (resus) beds, 3 triage beds and an overflow area that can take 4 or 5 patients. Usually if a patient is admitted they are moved to an unmonitored bed (if possible) and can wait there for quite a while, I have seen more than 24 hours. I don't see a solution though, upstairs all the beds are full, the floors are over census and pts are having to be put in the hall. The hospital is only so big...

Our overall LOS in ER is 2.5 hours for all pts. So we get ours up in good time. So often patient satisfaction is linked to LOS in the ER. Faster we get them up the happier they are, and thus the happier Admin is, and them we dont see as many suit types wandering around.

PS were average sized I guess seeing 60 to 70 thousand pts a yr in the ER

AirforceRN, RN · Apr 17, 2007

What happens when the hospital is full and you there is no place to put them?

PelicanLuvr · Apr 19, 2007

I think faxed reports from the ER to the floors is frought with potential disaster. The success or failure of the system is totally dependent on the individual ER nurses following the rules and making the necessary phone calls, etc. If this is not done, then the nurses on the floors would not be afforded the option of two way communication regarding the patient. JCAHO requires two way communication when moving patients from area to area. Faxing is only one way unless the phone call is allowed for.

If you really want to decrease the ER times for patients, I suggest you look at where the largest portion of the time is spent for these patients. I venture to guess it is not in the waiting rooms or awaiting the beds in most cases. The largest portion of the time is probably the 3-5 hours or more they spend in the exam room. If you could get your doctors to speed it up a bit, your ER dwel times would decrease more than if you merely try to shove them onto the floor nurses once a bed is assigned.

I assume your real goal is to increase your patient satisfaction. There are other ways to do this. One big one is to have your nurses interact with all of their patients. In our hospital this does not always happen. It is fairly common for the triage nurse to escort the patient to a room, and then the patient sits there until the doctor can get in there (sometimes well over an hour). Then any testing is done, and then the doctor must come back in to review it with the patient (taking sometimes over an hour again) and discuss treatment/discharge/admisstion. Then after about another hour, you finally see your ER nurse, who is there to discharge you. Where was the ER nurse during that whole time? Couldn't he/she have come in to introduce him/herself and offer to assist them if they need it? Or at least tell them how to contact them if they need something? They could periodically come back and check on you, which would make up for the fact that they must wait huge amounts of time for the doctors. Little things mean a lot when you are just sitting there . . . waiting, and waiting, and waiting. That's what ticks people off. And communicate when there is a delay. A little communication goes a long way towards making patients happy.