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

[nrsang97]

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?

[martymoose, BSN, RN]

i think our ed could care less where the pt goes, as long as they get them off their hands asap- they could care less about appropriateness. I swear 90 percent of my ed reports , the nurse didnt even lay eyes on the pt. I say this because of the reports I get- like "what is their hx? response= " oh, i dont know ,someone else had the pt and told me to give report.""what rhythm are they in?" "oh- seems regular" ughhhhh

And they wonder why we hate our job?

I suppose I should say that this is not always the ed 's fault- its the stupid factory production line mentality of management - let's fill every bed , no matter what. specialty and skills account for nothing. Thats why hospitals throw new grads in bad situations- they dont care.

ok end rant.

[eCCU]

In my hospital each nurse has their phone that they carry with them around. Floor nurses get an SBAR faxed to the receiving unit with the ER nurse tel#. The secretary then verifies with ER nurse SBAR fax received and pt is transported to unit. All ICU admissions must be accompanied by the ER nurse however the ER nurse must give verbal telephone report before transporting pt to IC

[eCCU]

In my hospital each nurse has their phone that they carry with them around. Floor nurses get an SBAR faxed to the receiving unit with the ER nurse tel#. The secretary then verifies with ER nurse SBAR fax received and pt is transported to unit. All ICU admissions must be accompanied by the ER nurse however the ER nurse must give verbal telephone report before transporting pt to ICU

[07302003, ASN, RN]

Last hospital - SBAR written report faxed from ER - floor, ICU - floor. ER / ICU RN calls to confirm they got it and answer questions. Patient is shipped out. ER-ICU is phoned report.

Now - ER-ICU is phoned report, ICU-floor is phoned.

The key is that MANAGEMENT must hold floor nurses accountable for answering the phone and taking report. If things are unsafe, they need to escalate things to management to defer admissions. If you are busy, your charge nurse takes report. Patients in the ICU and ER need to get moved quickly. (Not to sound ugly, I worked the floor for years, I know how crazy it is, but we are a team).

[Sugarcoma, RN]

I wonder if you work at the same place I do? We also have an issue with inappropriate admissions and report between ER/floors. Our floor nurses are not even notified they are getting a patient. Most of the time the patient just shows up. Occasionally if there is a HUC on duty and the bed is booked they MIGHT give the nurse a heads up but usually they do not. The other thing that makes this so unsafe is that the patient arrives with only a transporter! No RN in sight. I have to admit I would be very frustrated with this scenario also. Please someone notify me I am getting a patient so I can at least make sure the room is ready!

I work the ICU so we usually get a phoned report but not always. Our floor also gets notified so Charge can tell us the patient's name and we can access the chart and at least get an idea of what is coming our way. Occasionally we have had patients just show up but because they are critical an RN must accompany them so at least we can get some face time with the nurse to ask some questions.

I hate to give any credit to the last facility I worked in but I feel they handled transition from ER to floor much better than my current one. We had a bed pager that made an obnoxious noise to alert us a bed had been booked. ER faxed report and then called to ensure it had been received. If no one answered they called the charge phone. If no one answered charge phone they called the nursing supervisor who would walk down to the unit and verify it had come through. This report would list labs and procedures done with the results. We knew ahead of time if patient's needed contact precautions, stat labs, etc. They also had RN's acting as bed coordinator, which this current facility does not. It was not a perfect system by any means, but it was definitely better than what we have at this facility.

We have had some near misses lately because of the lack of communication. Many of the floor nurses have complained but management seems to think things are o.k. the way they are. I do not see it changing anytime soon.

[wooh, BSN, RN]

I always love the ED attitude that we should drop EVERYTHING immediately and take report. It's like you don't realize that there's a point when we're sitting there doing our nails on the floor, that if we were to pick up the phone, the polish might smudge. Sheesh...

[Runner1989]

We are a team, we understand the floor is busy too. However, we might be pushy because we know a code, trauma, or critical pt is coming in and we need that bed. We aren't trying to be unfair, ugly, demanding or rude we just want to be ready and be able to use the best resources on a critical pt.

[gardengal1, ASN, RN]

We use the same computer system as the admitting floors. When we call to give report to an admitting nurse, if they are not available, they MUST call back within 10 minutes, otherwise, the Resource Nurse takes report. During report, they have the chart open in front of them and can ask appropriate questions while the ER nurse is giving that report. It seems to work well when the nurse calls back within the 10 minute time frame. The patient then goes up immediately after report via transporter (except ICU patients which require a nurse transport and confirmation of drip rates at the bedside). There are rare call backs with questions when both of the nurses - the sending and the receiving - are looking at the same information at the same time.

[vickyvic1]

Don't send patients during shift change.

I have worked on the floor and now I work in the ER. We have a policy that no patients can go up to the floor during shift change. So for us, no transport or giving report of pt's between 7am-8am and 7p-8pm. We hold them in the ER til 8 then send the patient. We call and give a verbal report, if the nurses isn't able to take the call, we wait about 10mins. If the nurse doesn't call you back in 10min, then the patient goes up. We have the same system so the nurse can look up everything in the computer. If they have questions then they can call me back and I will answer them. All ICU/PCU pt have to be taken up to the floor by the nurse, so I can give a bedside report then.

[Flyboy17]

Sometimes, You really have no choice. In an E.R. setting we cannot tell a squad to wait till shift change and report is over

[vickyvic1]

We don't tell a squad to wait. We move the now stable pt into the hallway if we need the room.

[gardengal1, ASN, RN]

We NEVER hold a patient during shift change - that is what the Resource Nurse is for. Admits go up as soon as they are ready, no matter what time it might be.