How can we make the process of report from ER to floor better?

sapphire18 · Oct 23, 2012

We get a verbal report via telephone and then the nurse accompanies the pt to the unit and more details are given at the bedside PRN. We can look at the pts on the computer, but we don't always have time bc things move so fast; it's not an expectation to know anything about the pt before speaking with the ER nurse on the phone. Nothing beats a verbal report, IMO- easier to piece everything together when you don't have all day to go through someone's online medical record.

nrsang97, BSN, RN · Oct 23, 2012

I totally agree. This process just changed a few months ago. The floor staff hates it. ER says that they are signing out the charts so the floor staff can see them. IT is looking at this to make sure.

I think they need to go back to a verbal report. The only way that seems safe to me is a verbal report. I am returning to this facility after 6 years and I think this is nuts. I worked at our larger sister hospital for 6 years and we got a verbal report to the ICU and floors.

I am a Rapid response nurse and there have been so many calls from inappropriate admits. This could be avoided if the report was verbal.

Calixan · Oct 23, 2012

Hey,
I was wondering how your facilities give report to the floors/ICU/CCU. Currently our process isn't working and we are getting a lot of inappropriate admits to our med/surg floors. I have had a ton of rapid responses where the pt ends up in stepdown ICU/CCU, ICU/CCU, or life flighted out or transferred by EMS to our larger sister hospital.
Currently the report process is that the floor staff is to look up in the computer and be able to "read " the ER charting. However that is totally incomplete, the chart isn't updated so floor RN's can see VS, etc until after the pt is admitted on the unit. There is no opportunity to ask questions. They get a call from transport saying the pt is coming and then the pt is in the unit 15-30 minutes later.
Our charting is in two seperate systems. ER uses one system and the floors use a different system to look at labs, and test results.
What is your report process?

In the ER I work in currently we do verbal reports but in the ER I worked in previously, we did SBARs and that seemed to work out well. Basically had all the general info on the patient, name, age, hx, allergies, current vs, sx, etc. Then that was faxed up to the floor and the patient was sent up 15-20 min later. If it was a critical sick patient like on going to the unit, then yes we called report. Sometimes I like the calling report thing but a lot of times I wish I could go back to sending SBARs just because usually when I call the floor the nurse is "too busy, giving meds, in with a sick patient" etc. Oh well, nursing isn't easy and I guess communication about patients isn't either.

One1, BSN, RN · Oct 23, 2012

We give phone report prior to pt transport but also run into the issue of the receiving nurse not always taking report when we call. We will note the time and number of report attempts in our documentation. If the floor will not call back or take report in a reasonable amount of time we can fax report to the floor nurse instead. When the floor takes report over the phone though I agree that it is more beneficial for the receiving nurse.

nrsang97, BSN, RN · Oct 24, 2012

In the ER I work in currently we do verbal reports but in the ER I worked in previously, we did SBARs and that seemed to work out well. Basically had all the general info on the patient, name, age, hx, allergies, current vs, sx, etc. Then that was faxed up to the floor and the patient was sent up 15-20 min later. If it was a critical sick patient like on going to the unit, then yes we called report. Sometimes I like the calling report thing but a lot of times I wish I could go back to sending SBARs just because usually when I call the floor the nurse is "too busy, giving meds, in with a sick patient" etc. Oh well, nursing isn't easy and I guess communication about patients isn't either.

I understand about the nurses not being able to take report. I have been the recieving nurse and will ask to call back if I am doing a IV or sterile procedure or have someone transfer to my charge to take report. Even if they did the SBAR form, and left their call back number that would be better than what is happening now.

ecerrn · Oct 24, 2012

IMO the call you back thing happens so much as to be considered taking advantage of. When the Med surg charge nurse takes the report immediately it goes smoothly, then you can continue your sterile procedure or v/s uninterupted and the er can offload that shock pt from the ems guerney and get him stable quickly. Win win. Call you later wastes so much time...even five minutes is too long a wait, besides, when you call back, now I'm stating a few ivs...where does it give?

noyesno, MSN, APRN, NP · Oct 24, 2012

Don't send patients during shift change.

sserrn, BSN · Oct 24, 2012

^^ I'll bear that in mind...as soon as pts. stop presenting to the ER during shift change. IJS.

sapphire18 · Oct 24, 2012

^^ I'll bear that in mind...as soon as pts. stop presenting to the ER during shift change. IJS.

What is IJS?

nrsang97, BSN, RN · Oct 24, 2012

What is IJS?

I'm just saying.

Esme12, ASN, BSN, RN · Oct 24, 2012

I'm just saying.....IJS....is txt talk (Per our Terms of Service please post in English only; no text/chat speak;)) for......

I'm just saying.

I think that constructive communication between the departments is imperative to ensure patient safety and provide the patient with optimal care. When departments stop communicating is when issues arise. Handoffs and signouts have been linked to adverse clinical events in settings

I am concerned about this process for it does not fulfill The Joint Commission requirements for report.

An estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off. In addition to patient harm, defective hand-offs can lead to delays in treatment, inappropriate treatment, and increased length of stay in the hospital. Ineffective hand-off communication is recognized as a critical patient safety problem in health care. The “hand-off” process involves “senders,” the caregivers transmitting patient information and releasing the care of a patient to the next clinician, and “receivers,” the caregivers who accept the patient information and care of that patient. The Hand-off Communications TST:
Facilitates the examination of the current hand-off communication between two settings of care from the view points of both the senders and receivers involved in the process.
Provides a tested and validated measurement system that produces data that support and drive the need for improving the current hand-off communication processes.
Identifies areas of focus, such as the specific information needed for the transition that is being measured. For example, the information needed for a hand-off from the emergency department to an inpatient unit differs from that needed for a hand-off from a hospital to skilled nursing facility.
Provides customizable forms for data collection to fit the specific needs of the transition being measured.
Provides guidelines to determine the most appropriate and realistic hand-off communication process for a given transition, while also empowering the staff involved in the process.

The AHRQ, Agency for Healthcare Research and Quality (a division of the dept of HHS) makes recommendations as to the content of handoffs top avoid mistakes and sentinel events.

Implementing Structured Handoff and Signout Protocols
Current signout mechanisms are generally ad-hoc, varying from hospital to hospital and unit to unit. Guidelines for safe handoffs focus on standardizing the signout mechanism. The components of a safe and effective signout can be summarized using the acronym ANTICipate:
Administrative data (eg, patient's name, medical record number, and location) must be accurate.
New clinical information must be updated.
Tasks to be performed by the covering provider must be clearly explained.
Illness severity must be communicated.
Contingency plans for changes in clinical status must be outlined, to assist cross-coverage in managing the patient overnight.
Several guidelines have been developed for implementing standardized signouts. One trial of a computerized and structured signout system in an academic medical center demonstrated improved efficiency and more time spent in direct patient care after implementation. Innovative signout strategies have incorporated practices from other industries, such as the adaptation of a signout strategy from Formula One auto racing to the handoff from operating room to intensive care unit. In nursing, the SBAR method (Situation-Background-Assessment-Recommendation) has become widely accepted not only as a signout tool but as a structured method for all communications between providers.
Current Context
The Joint Commission requires all health care providers to "implement a standardized approach to handoff communications including an opportunity to ask and respond to questions" (2006 National Patient Safety Goal 2E). The Joint Commission National Patient Safety Goal also contains specific guidelines for the handoff process, many drawn from other high-risk industries:
interactive communications

up-to-date and accurate information
limited interruptions
a process for verification
an opportunity to review any relevant historical data

So......I don't believe that "looking it up" on the computer is adequate nor does it fulfill any of these requirements.

OP........... it sounds to me that this facility has had a particular problem of stonewalling when it comes to admission assignments and acceptance of the patients. I commend you for coming to the source to try to brainstorm on how to better improve this process. I have worked at these facilities and the amount of energy that is wasted on hiding beds, evasion tactics to avoid report, the ED dogged determination to get rid of the patients in the ED when the ED MD decides to drag their heels until it's time for them to go home so they don't have to work up anymore patients than necessary...... :banghead: ...is the bain of everyone's exsitance.

We ALL know about the historical discord between the ED and everybody and everybody with the ED. It seems to be the nature of the beast.......sigh.

So, what do we do about this.......first everyone needs to respect/cooperate/communicate, but enforcement of the respect/cooperation/communication needs to be at all levels. There needs to be admission and discharge criteria for every department that set guidelines for the patients condition, admission and vital signs.

All departments have their own set of circumstances/experiences that set the tone. Then there are certain facilities that no matter how hard you try it is next to impossible to change the culture for they are perfectly happy just as they are and will go to great lengths to preserve the status quo.

What I have found is that a standardized faxed report with the standard information listed above, with meds/treatments in the ED clearly listed, faxed to the floor beginning an hour time clock to the patients discharge from the ED and admission to their respective unit works the best. Time arrival negotiation for extension needs to go from the charge nurse to the supervisor (at least at first) to explain the need for greater time or concern for the patients stability.

When the ED complains it is double charting....it is. But is assures that everyone is on the same page.....it sets a clear timeline keeping everyone in the "know" of the patients timeline/arrival and that everyone knows what the expectation is and knows what is expected of them.....so there is no confusion.

I hope this helps...good luck!