Getting report from the ED

KulRN · Aug 18, 2007

We used to do phone report as well and I must say I hated it because it's not as accurate as how I want to be....some nurses would phone report 2 hours or even longer than that and would not even do an addendum prior to pt's transfer. Now we do phone report for pts coming from the ER and I ask every questions I can think of....I'm sure ER nurses are annoyed by it but oh well isn't that the reason why we give/get report in the first place???? And when it's end of shift report, I like to do the bedside report so that I can see my patients face to face. There was a couple of situations where I found my patients not in good shape during report and I question the night nurse...

Altra, BSN, RN · Aug 18, 2007

This is a difficult issue.

Where I work, we fax report and what we fax is the actual nursing documentation. So in the example you give, you (the receiving nurse) could see what interventions were done.

However, the drawback is that we've learned that these "faxes" which actually go straight from our computers to the fax machines on the floor sometimes get hung up with all the other network traffic floating around the network. So we started faxing as soon as a bed was assigned, even if the patient wouldn't be going up for a while. The downside of that, of course, is that things could have changed radically in that interim time. I do my best to fax again if that situation occurs but then what has happened is that the unit clerk or even the nurse on the floor sees the documentation on the same patient, says, "oh, we already got this" and pitches it. Sometimes ya just can't win.

As for verbal report ... how many hundreds of threads here at allnurses.com deal with rants of every conceivable variety about giving/getting report? Many, many people either cannot be flexible or cannot be polite about asking questions about things that they consider to be important. So please understand why I think that going back to the phone tag and frequent confrontational conversations that come with verbal report is not the answer.

I guess another alternative would be for nurses to transport ER patients to the floor and give face to face report on the patients. When someone figures out who is going to watch my other 5 patients while I do this ... then I'll be happy.

nursej22, MSN, RN · Aug 18, 2007

Report, argghhh!

Yes this is always a topic of heated debate, shift to shift, unit to unit. I was of the understanding that Joint Commission had mandated direct nurse to nurse hand-off. Our facility had interpreted that to mean either an inperson or telephone nurse to nurse report must take place. Of course this gets side-stepped often by having a nurse who didn't care for the patient call report, or a phone message " read the computer, call me with any questions" and then leave before questions can be asked!

This had seemed to cut down on patients being transferred out of ED with active, untreated chest pain. We have a report template that is supposed to be followed, but seldom happens.

My pet peeve: calling report on an in-hopsital transfer with computer charting complete, but recieving nurse has not taken time to look at it, and asks me location and size of IV access and diet. Sometimes I am evil and reply, " I don't remember, let me bring them up on the computer."

EmmaG, RN · Aug 18, 2007

The last place I worked had faxed "reports"--- if you want to call it that. No mention of the patient's chief complaint. No documentation of assessment (by nurse OR physician). No documentation of interventions beyond a few (usually) illegible chicken-scratches, generally just listing a few meds (but not noting the time or route given). No documentation of the response to these interventions. Occasionally included a copy of the ED doc's initial orders, many hours old and with no notation of what was or wasn't done. It was horrible and, in my opinion, dangerous.

Sometimes the patient would just appear. The ED was not required to notify us when they were bringing the patient up, nor did they notify the floor staff when they arrived. Many times, I'd walk by the room and there they would be.

This hospital had an inpatient admissions unit where some patients would be processed through on the way to the floor. Those nurses called report.

As far as what was posted above, I don't care so much about the size and placement of an IV, unless there is something unusual about it. I just want to know if they have IV access. And diet isn't important unless the patient is NPO for a procedure. Those are things I can figure out once they reach the floor. I want to know why the patient came to the ER, what's been done for them, if there are any special needs when they arrive to the floor (NGT, O2, etc).

There needs to be some give and take from both sides here. We're all supposed to be on the same side here.

ohmeowzer RN, RN · Aug 19, 2007

the Ed just faxes us a little report sheet and thats all we get. they also bring people up just as we are going in report.. grrrr , by the way all smiles RN i love your user name.. it is so cute.. makes me smile:)

AngBthatsme · Aug 19, 2007

We get phoned report from the ED. I swear sometimes I'm getting report from the tech. Half the time it is a nurse who did not take care of the patient. They pick up the chart start flipping through pages and reading. I only want the important information, Im not going to quiz you about where the IV is, I'll figure it out. I have 5 other patients to take care of so hanging out on the phone with the ED nurse is not where I want to be. One thing I do want as a night nurse though, is a list of home medications. It is our policy that the ED nurses fill out the medication reconciliation sheet. The doctors want the list when I call for orders or they need it the next morning when they round. Unfortunately many family members go home after the patient has received a bed and is going to the floor. Last week I had a nurse give me report and at the end of report I asked her to please make sure the medication reconciliation form was filled out, her response "there are orders on the chart and Im not filling it out". In a non confrontational way told her that it is important that she get that filled out before transport. Her response "Im a charge nurse and Im not filling it out". How quickly we forget why we punch in.......it is for the patients right? :uhoh3:

GrnHonu99, RN · Aug 19, 2007

At my hospital, we have done away with telephone report for ED admits. In the past few months it was moved to computerized report; this is a non-permanent portion of the chart where the ED nurse types a note to the nurse accepting the pt. I get really frustrated at times. I understand the ED is hectic, but I'm tired of the lack of report I receive. For instance, I will see the admitting diagnosis of acute MI. I can see the labs. The nurse will write: "cp radiates to L arm with diaphoresis." Ok, how about what you did to treat the pt? Or if the pain is relieved? Or if cards is on the way to perform a cath? Just give me a little something more. Is that an acceptable report? Not to me. This happens more often than not, one or two sentence report. Sometimes report is not even sent. All of a sudden the pt is on the floor and you don't know a thing. I understand everyone has an off day and I know the ED gets slammed. But something has to change. When the situation has been serious, I have initiated an incident report to hopefully aid in identifying a better way to provide continuity of care. Anyone been in a similar situation? What changes were made?

Doesnt sound good...doesnt give you the chance to ask questions! I always have questions. However, we still have phone reports and most of the time I still know little to nothing when that pt. hits the floor. But i do always have the chart, so I can get it from there. Ive had a couple of pts hit the floor before ive even got report...lol...

ERRNTraveler, RN · Aug 19, 2007

On the flip-side, please see the following thread: https://allnurses.com/forums/f18/transferring-pts-ed-floor-233999.html

Just a little insight from the other side of the issue....

Eyefish999 · Aug 19, 2007

I work night shift on ortho/stroke unit and i frequently get crap reports form the ER, they send up patients with hip fx without a foley or any pain meds ordered, send up change in mental status patients R/O TIA/stroke not on any stroke orders or even worse they send the patient to us with + cardiac enzymes, or they send up a patient that has orders to go to a telemetry unit with dysrhythmia protocol(one time they were sending up a patient to our floor that coded on the way that turned out to have orders to send to ICU in the first place...then when you ask the ER nurse what type of orders they have they say "im not reading that to you" sending up patients without name/wristband that is unresponsive,,they tell you the patient is AAOX3 when they are really demented AAOX0, they "dont know" if the patient has a foley or not. tell me the patient is in SR/ST then when i connect them to remote tele they are A-fib 130 or SVT. or they say the patient assessment is "benign" and when you get them they are lethargic, BP 230/110 severe wheeze rales, bradycardia, diarrhea, huge stage III decub the size of my hand,huge weaping midline abd incision from bowel resection 2 weeks earlier , incontinent of urine, demented,,they also forgot to tell me tha patient did not have any legs. just had to rant. ohh last but not least just leaving the patient in the room without telling a nurse secretary or aid of the patient arrival.

EmmaG, RN · Aug 19, 2007

I hear ya.

Our ER was famous for leaving out the fine details. One of my favorites was the 38 year old female admitted with r/o pneumonia.

When the supervisor called for the bed, I asked if she wanted private or semi. He said the ER told him she had no preference.

I suppose she didn't; she was s/p stroke, brain-damaged/comatose with a trach.