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

Altra, BSN, RN · Apr 19, 2007

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.

The scenario you present is, IMO, atypical. Is this your experience working as an ER nurse in your hospital, or your experience as an ER patient?

It's true that a non-emergent patient may wait some period of time before being seen by a doc. However, in that time, the nurse will have assessed the patient and, in all likelihood, started a line, drawn labs, administered Tylenol/Motrin for fever according to facility protocol, and/or ordered x-rays, again according to facility protocol. Your scenario seems like all interactions w/the pt. are driven by physician orders ... I can assure you that that is not my working experience.

Yes, there are those nightmare days when I can see a "new" patient walking back but I have 2 others who are crashing. It may be an hour before I can get to them. But again ... by definition ... this will be a non-emergent patient. My charge nurses will notice this, and have a tech or another nurse get things started for the new patient.

Teamwork. Priorities.

PelicanLuvr · Apr 20, 2007

I guess that our ER is atypical then. For this is what generally occurs. Except if you are in with something more urgent such as a heart attack or a stroke, of course.

dazey71 · Apr 20, 2007

I hate faxed reports. I work on a med/surg/GI floor and got my report faxed. The orders are "Admit to ICU. DX: ETOH withdrawl"

Before I can call the ER to find out what is going on, up comes a guy on a stretcher in full-blown DTs.

I hate faxed reports.

ecat81 · Apr 21, 2007

We fax our reports up to the floor and it works well for us. We call to confirm that the report was recieved and then the pt goes to the floor. Jacho stated to us that report was a courtesy. We fax then the pt goes up. We only go to the floor with pt's on cardiac gtts or to the unit. About the "let me get the room setup" ...never happens. We repeatedly go up and nothing is in the room except the tele monitor. We have to pull sheets back, move chairs out of the rooms, move bed side trays, poles, to be able to even get in the room. We try to get all pts to the floor in 30 mins due to the fact of our high mumbers in the ED. We average 165 a day right now and increase every year by double percentages. The floors seem to delay the inevitable. We have no control over our influx and most floor nurses dont understand or care about that. On the floor they pitch a fit wanting all meds, labs, etc done before the pt gets up to the floor and a full report. Sorry not going to spend 10 minutes going over the pt for your assessment. Do your own. During that 10 minutes we had 5 ems arrive with 3 traumas and a code and still have 28 pts in the lobby waiting for over 4 hours now. What really gets me is when we do get a chance to run to the cafeteria to get food to eat cold a few hours later the nurse I just took a pt to is sitting in the cafeteria eating with a tech and another nurse off the same floor-How nice. Sorry for the rant but thought I'd give my thoughts.

Altra, BSN, RN · Apr 21, 2007

I guess that our ER is atypical then. For this is what generally occurs. Except if you are in with something more urgent such as a heart attack or a stroke, of course.

I'm curious ... do you not start a line, draw labs & other stuff that you know will be ordered? Do you really have to wait for the doc?

Unless you have a crashing patient or are otherwise legitimately tied up, woe to the nurse in our ER who would have a patient sit for an hour with nothing done, regardless of whether or not a doc has seen the pt.

ecat81 · Apr 21, 2007

We are very autonomous in our ED. As soon as a pt is brought to a room we do draw a rainbow, send urine, get an ekg, start our bedside cardiacs, etc etc. We cant afford to wait til the doc sees the pt due to the fact that we are so busy. But we also on the other hand have great docs. We have 9 board cert. ed docs not family physicians or other docs. right now and have 4 physician coverage everyday, plus a pa in the express from 10a-10p. and 3-4 days a wekk we have a pa that sees pts in the main ed from 5p-5a. Im talking about the fact that the pt has orders to go upstairs and the nurses on the floor want everything done so they can put them to sleep and not do anything else. to include nightly meds, etc. We do all the orders our ed docs order plus even some he admitting docs want done. I have had pts go to the med surg floor and 1.5 hrs later they call stating we cant find the orders on pt so and so. Hmmm you mean that you havent seen the pt in 1.5 hours and they are under your care. It would be different if you went to the floor and there wasnt 4-5 nurses and 2-3 techs sitting at the nurses station when you walk by and you still have to ring the bell to get them to come receive the pt.

RunnerRN, BSN, RN · Apr 23, 2007

Wow....I would not want to work or be a pt in Pelican's ER! As was stated above, the nurses in my ED are EXPECTED to get an IV going, order the appropriate labs, and get appropriate dx tests going (CXR, head CT, extremity injury xrays, EKG). Even if there is a 2 1/2 hr wait to see a doc, you will see that all of my patients are lined, have at least a CBC and CMP in the lab, and have had dx tests. If they're in pain or nauseated, I will get an order from a doc for some Toradol/MS/Zofran.

The idea of an RN being responsible for a pt they have never laid eyes on until DC is very scary.

teeituptom, BSN, RN · Apr 27, 2007

faxed or verbal with either form of communication done well nothing ever changes

stayseerrn · May 4, 2007

Faxed reports brought the same problems phone reports did. The list of reasons: the fax was out of paper, the nurse hasn't had time to read the report, it is almost time for shift change and the nurse can't take the patient now, we didn't receive the fax, etc. This occurred even when we would fax the report, call the US to confirm receipt (and even document such), and then call the floor when the pt was on the way to let the floor know. I spent more time filling out the form and all of the follow ups than I did actually giving phone reports. But at least it helps with the whole hand off communication thing JCAHO is big on right now. It gives you documented evidence of what was communicated during report, but it does not decrease length of stay in the ER.