"The Golden Hour"

[Tait]

"The Golden Hour" is a term my facility uses to dictate an hour of time from 645 and 745, during shift change, where patients are not supposed to be transferred to the floor. It was believed this hour of time helped decrease patient deaths and increase safety.

It has come to my attention that this practice is now being lifted at my hospital. It is believed that due to telephone taped report there does not need to be this lag in transition as more nurses are available on the floor.

I am curious as to how many of you work for facilities that have this practice, have had it in the past, or have never heard of it. From your varying experiences what are your feelings on this practice? Important? Cumbersome? Meaningless? Safe?

[nursej22, MSN, RN]

We have a policy of no patient arrivals (admits or transfers) and no called reports between 0700-0715, 1500-1515, 2300-2315 so that on-coming RNs can get uninterrupted report. The first five minutes is "huddle" then we get 10 minutes to get report on 4-5 patients from 2or3or4 off-going RNs and the computer. What a joke.

This is in no way enforced. Team leaders are in report at this time so no one says boo about it.

We get patients from multiple areas (ICU, ED, cardiac recovery, PACU, admissions area, direct admits) so it is not uncommon to see 5 stretchers in the hall at 1510. When the ICU nurse gets pi$$y with me because she had to wait 2 minutes I tell her to take it up with the ED, they beat you up the elevator and I had to call a rapid response on that one.

Our manager "understands that this could be a problem", and "we have to have that conversation". At that is as far as it goes.

No sentinel events.

Yet.

[elthia]

That would be heavenly...unfortunately no we don't have it.

In my facility nurses do the first set of vitals on the patients. So when I had a code at 2030 yesterday...I sent the aide to finish my vitals, and didn't get to see one of my patients till 2145, had to redo my 2100 chemsticks, finished my 2100 meds at midnight, and did all my dressing changes and treatments at 0200. Lovely.

The ED sent an admission while the emergency response team was working on my patient during the precode time....but a different nurse took it for me. And I took an admission at 0100.

[MTRN13]

I think it is a really good idea. Unfortuantely at my hospital we do not have it. Although from 0630-0700 if there is an admission or transfer we only take the vital signs, and a quick assessment to make sure they are stable. If the patient is from PACU then we get report, and then endorse. We are working making ER and PACU give pain and nausea medications before they come to the floor. Especially from ER so the patient does not have to suffer while we are waiting for admitting orders from the doctor.The paperwork, and responsibility is on the oncoming shift. If I have time I try, and do a few quick things to speed things up for the oncoming shift. At that time I cannot make any guarantees. I do not think it is the safest practice to send patients up during the "golden hour" also it is not uncommon to hear a code or rapid response at change of shift. I do not know why it is, but it is so strange since we make hourly rounds.

[Roy Fokker, BSN, RN]

I work ED.

And I'm not surprised that my post is against the general grain of thought so far in this thread.

The only unit that has this policy in place is ICU. Cannot bring a patient up from ED to ICU between 0630-0730 and 1830-1930. All other floors are expected to take admissions no matter what the time.

I don't agree with it (can I tell the ambulance crews coming in with a cardiac arrest to hold off for an hour because it's 0635?) - but it is what it is.

Yes, it sucks to get patients during shift change.

But it's shift change everywhere.

cheers,