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?

[RNJill]

I know that this has been said, and I know that this is going to sound snarky, but it is seriously annoying that *every* patient seems to come up during shift change....as in, there are multiple empty beds on the unit and suddenly, between 6:45-6:55, 3-4 pts show up from the ER! I do (to a point) understand the "people are always coming to the ER" concept, but find it suspicious that so much of it happens at shift change.

[Runner1989]

It is also very interesting that where I work at shift change all our patients get their bed assignments. I could say it is equally suspicious.

[Altra, BSN, RN]

I know that this has been said, and I know that this is going to sound snarky, but it is seriously annoying that *every* patient seems to come up during shift change....as in, there are multiple empty beds on the unit and suddenly, between 6:45-6:55, 3-4 pts show up from the ER! I do (to a point) understand the "people are always coming to the ER" concept, but find it suspicious that so much of it happens at shift change.

It is also very interesting that where I work at shift change all our patients get their bed assignments. I could say it is equally suspicious.

You know that this is a bed control problem, right?

I've said this before in this forum ... just about every day my ED tracking board lights up with assigned beds like magic at about 5 - 6pm. So yes, we in the ED are suddenly "dumping" multiple patients on the floors because that is when the beds have been assigned.

Work with your management to figure out whether this is a housekeeping problem, some other problem with bed control, or just a nefarious conspiracy.

[CP2013]

You know that this is a bed control problem, right?

I've said this before in this forum ... just about every day my ED tracking board lights up with assigned beds like magic at about 5 - 6pm. So yes, we in the ED are suddenly "dumping" multiple patients on the floors because that is when the beds have been assigned.

Work with your management to figure out whether this is a housekeeping problem, some other problem with bed control, or just a nefarious conspiracy.

Sometimes bed management is assigning at that time. Some times one shift of docs is on their way out and wants to clear up before they leave the patient for the next shift, so they throw up admits and discharges all at once. Where I used to work, we had docs throw up admits at 6, and they were going to the floor by 7. Every single shift.

The nurses hated it because it often meant they has to stay late to give report to the floor or worse, give report to the oncoming shift so they could give report to the floor!!!

[Runner1989]

You know that this is a bed control problem, right?

I've said this before in this forum ... just about every day my ED tracking board lights up with assigned beds like magic at about 5 - 6pm. So yes, we in the ED are suddenly "dumping" multiple patients on the floors because that is when the beds have been assigned.

Work with your management to figure out whether this is a housekeeping problem, some other problem with bed control, or just a nefarious conspiracy.

I would agree it is a bed control problem...it is always so busy with admits from ER and upstairs is usually full so it creates a grid lock.. They say they are working on it but I feel like it hasn't gotten any better maybe even worse...

[NurseOnAMotorcycle, ASN, RN]

You know, it's interesting to think about.. there has been a rash of "Their bed's assigned but the charge said to hold onto them until 23:15 before sending them..."

I wonder how much of it is the previous shift piling things onto their coworkers?

Edited to add: that makes it hard on us and our transporters, too.

[DC Collins, ASN]

We use the report form that the floor (various departments) use to give shift reports. We fill in the stuff that we can answer on those forms and then have them in hand when we give report. That way we at least know what type of info they are looking for.

DC :-)