giving report to the next level of care

wooh, BSN, RN · Feb 28, 2012

When we've had patients come to the floor unstable, we've refused to take the patient off the stretcher and put them in the room, we hold them in the hall until the admitting MD comes to look at them. If it's one of the more useless MDs, we call a rapid response in the hall. Not worth dirtying the room for the pitstop when they should go ahead on to the unit. :)

A couple times of doing that, and the ED docs are putting a little bit more effort into the floor vs. unit decision. Even making sure that the admitting MD looks at the patient before leaving the MD if the patient is borderline.

I'd rather get report before they come up. That way I know if I need to set up O2 or suction or even just have a couple minutes to mentally prepare. But I've learned, change only happens when the MDs are inconvenienced. So to fight something, I just make sure the MDs are as incovenienced as I am. :)

jlog.j · Feb 28, 2012

That is a very good idea, to call the rapid response team. Would this scenerio be considered pt. dumping? Would this be considered a EMTALA violation? And you are right, if I inconvience the doctors enough maybe they will like you said "put a little more effort" into deciding on who to admit. Thanks for the info.

tokmom, BSN, RN · Feb 29, 2012

Are they developing any process of how this is going to be done? We just implemented something like this and it's working fairly well.

We actually started this process in October and just wrapped it up in January. We too are a small hospital (do I know you? lol) but we pulled everyone on from registration to Med/Surg. We had no clue how the other dept worked so they put us all in a room to break the myths we all had about everyone's process. Ed had to totally redo their workings for this 30 min from bed assigment to floor.

Our process is as follows: We are informed of an ED admit from the supervisor. We can also watch the ED tracker to see where they are in tests, etc... Once that pt is placed in a holding pattern for the ED to enter orders, we know we have those 30 min. The ED then voscera's us that the pt is moving up the elevator. The attending nurse and CNA head to the room to greet the pt.

We have had a few pt's that were not very stable and had to be moved to ICU. The good news about that, it's only happened once. with two nurses who were retrained. Our motto is to not pass along garbage. Don't send us a pt with no paperwork or too sick for the floor. Those nurses get in trouble.

We, as in med/surg and ED, meet twice a month to review this process.

If it's done correctly, it works.

jlog.j · Feb 29, 2012

Thanks for sharing your experience. Glad to know we are not the only ones having issues like this. We do not have an ICU, so not sure what we will do if we get an unstable pt. I'm having a hard time dealing with this "for profit" hospital now (we use to be not for profit). My co-workers and I are very afraid of losing our licenses as one of our co-workers did recently with this company.

Altra, BSN, RN · Mar 1, 2012

What do you do now, with patients whose condition deteriorates to the point that you cannot care for them in a med-surg setting? And how is this different in the new bedside report system?

jlog.j · Mar 1, 2012

We have to transfer the pt out to a larger hosp. about 80 miles away. Currently now, the ER will call M/S,speak to the charge nurse & tell her a little about the pt. so as to assign an appropriate room, we obtain a copy of the orders, within about 15 or 20 minutes the ER will call to give us report, then the pt arrives within about 15 or 20 minutes. The problem we have had in the past is that the ER will not fully disclose things like the pt is having unresolved chest pain, that the pts BP is still sky high, even after multiple BP meds, etc.

Vespertinas · Mar 5, 2012

What I'm understanding is that the only change to your process is that your patients will be coming to the floor a little sooner only after the bed has been assigned. This should not cause the ED to rush unstable patients to your floor because presumably, a med-surg bed would not be assigned in the first place if the patient was still unstable.

It sounds like a great idea to me to make efforts to eliminate the time between bed assignment and floor arrival. Judging by the bed assignment, the patient is ready to be out of the ED so extra time spent in holding is wasted time.

jlog.j · Mar 5, 2012

The only thing is that too many times (b/c this company wants as many admissions as possible and the ER doc comes down to the floor and states "I have to meet my quota") we, the m/s nurse does not get the true picture of the pt. and like I said we do not have an ICU to transfer a critical pt to, we have to transfer to a hospital 80 miles away. It would be much safer for the pt to go ahead and be transferred from the ER, it is much quicker to do a ER to ER transfer than M/S to ER. But NOOOO, we don't make any money that way, we have to have ADMISSIONS (whether they are appropriate for our unit or not. Its very sickening to see how these "for profit" hospitals are ripping off medicare. They either admit people who do not need or want to be in the hospital at all or they admit people that are not stable enough for our small hospital. They are gambling with these peoples lives.

silentRN · Mar 5, 2012

our healthcare system is always about the money now...our federal and state governments are always talking about health care cuts, while the hospitals are always trying to cut corners to keep the hospital afloat. Money is what keeps the doors open, and with hospitals getting less reimbursement money will always be an issue.