How do you, on a Med-Surg floor, get report from the ED?

rachelgp · Dec 12, 2007

I work in the ER and we use a sheet that has blanks for diagnosis, admitting dr, recent vitals, diet, pending labs, wounds, pending procedures, and room to write a little extra if needed. We actually send it by the tube system, and then call to make sure they received it and see if they have any questions. There's a spot to check off that the unit was called for final discussion.

Hope this helps!

Rachel

fibergirl · Dec 12, 2007

In the ED I work in, nurses still call the floors (usually two or three times, back and forth) to give verbal report. same with the docs. interesting about using the tube system... although, we never have enough tubes around to send bloods when we need them!

brent_25, RN · Dec 12, 2007

A phone report is ALWAYS the best way to endorse a patient - but occasionally our ED will have to give a written report - if the receiving nurse is unable to come to the phone. Of course, we have 'guidelines' on which type of patient we can send a written report on - they have to be (obviously) stable, not requiring cardiac monitoring (no telemetry floors), no infusions that would require increased monitoring (heparin, cardiac meds..), no isolation, and only to regular med/surg floors (no ICU etc)..and only after at least 2 attempts to give a verbal hand-off. If we decide to send a patient up with written report - the receiving nurse must be made aware of this - we would never send a patient up without letting them know first. Patients should never just 'show up' on your floor. Also - on the written report sheet there needs to be the name of the nurse in the ED, and a local so you can call them if you need something clarified regarding the patient once you receive them.

Hope that helps..

Brent.

FireStarterRN, BSN, RN · Dec 12, 2007

My hospital recently went from the ER nurse calling to give the floor report, to faxed reports. There have been numerous problems since this change. From missing information to the ER missing stat orders to the patient being admitted since the evening, and the floor getting the pt. at 3 because the nurse went home then to the floor not knowing the report was faxed and the patient rolling onto the floor without any knowledge of them. Needless to say it has been a nightmare.
We are now revamping the report sheet to see if it could be made better, so the ER and the floors are happy. So I guess I have 2 questions. How do you get report from the ER? And if it's via a faxed report, what makes the report sheet work for your hospital?
Thanks.

We went to this at our hospital and it's been sorely abused by ER, it's been a failure and I think we might be going back soon because we have had numerous breakdowns in communication. They've left out information, they started sending techs up with the patients, they've even done this for stepdown and ICU patients. Then, they get uppity when you call to ask questions. Even though they initially fought the whole idea, they say they sent a faxed report, that should be enough, even when the faxed report in incorrect/ and or incomplete.

We've had some recent incidents that have caused management to re-examine the issue.

Blee O'Myacin, BSN, RN · Dec 12, 2007

My hospital recently went from the ER nurse calling to give the floor report, to faxed reports. There have been numerous problems since this change. From missing information to the ER missing stat orders to the patient being admitted since the evening, and the floor getting the pt. at 3 because the nurse went home then to the floor not knowing the report was faxed and the patient rolling onto the floor without any knowledge of them. Needless to say it has been a nightmare.
We are now revamping the report sheet to see if it could be made better, so the ER and the floors are happy. So I guess I have 2 questions. How do you get report from the ER? And if it's via a faxed report, what makes the report sheet work for your hospital?
Thanks.

In our ER, we fax the entire computer database to the floor (med/surg and tele patients only - PCU and ICU get verbal report). Then we have to call, touch base with the receiving RN and then we will either send the patient up (m/s) or escort the patient w/the tech (tele, ICU, PCU).

Coming from working the ICU and the PCU to the ER, my pet peeve is that the floor nurse does not "know how to read" the faxed report. (seriously, this is the comment I get frequently - "I don't know how to read this thing, can you start with the medical history??") I don't think that the floor nurse is being difficult, I think it comes from a lack of training and that the ER uses computer based charting and the floors are all on paper. I wonder sometimes if repeated inservices from the ER would be helpful. A monthly visit to the floors to answer any questions, discuss any communication issues between staff, that sort of thing. There is no reason why we all can't work together. There are times when I have to explain that the 1830 transport to the floor is necessary as there is a 4 hour wait in the waiting room and the triage nurse had to get security to keep the angry sick people at bay!

Blee

sofaraway04 · Dec 12, 2007

I work on an acute medical ward in the UK, when we get a patient admitted from the emergency department, we will get a call from the bed manager to let us know the name of the patient and check that we are ready for them.

The nurse from emgerncy department will then accompany the patient to our ward and give a verbal handover. i find this pretty good because I can ask any questions about the patient.

CaLLaCoDe, BSN, RN · Dec 12, 2007

At my hospital we receive a NO DELAY fax with information of the patients status (Vitals, Assessment check off), the medications (sometimes written as check MAR! which doesn't help much), and the room number to be transferred to, the signature of the nurse writing the form which aught to be printed because it is often times difficult to read!

Some nurses are fortunate when the ER nurse faxes the admitting orders before the patient gets to the floor. Usually the NO DELAY will be sent to our department via tube and fax with a follow up phone call from ER.

When the patient does arrive to our floor the patient is accompanied some of the time, rarely nowadays by the ER nurse. Most of the time lately it has been another nurse who doesn't know the patient and will state, "I'm just the delivery boy!" This really doesn't help matters much. I suppose the ER doesn't want to be barraged with questions when the patient arrives; but, what is the point of transferring care to the floor without making sure there is a follow through?!

nursemoons14 · Dec 12, 2007

We recently adopted this fax report, and being an ED nurse... I love it. A lot of the floors, and im not saying all, tend to abuse the telephone report giving excuses like "oh that nurse is on break", "oh that nurse is with another pt, she will call you back " ummm no she won't because im giving report to whoever is covering for her/him. Fax report has been a Godsend, there's no more of this "The beds not ready." I mean it doesn't solve the fact at our hospital that 22 out of 36 ED beds are admited pt's waiting to go to the floor but it atleast lets us see more acute pt's like the chest pains in the waiting room getting CK/Trops done in the triage stretcher.

Our faxed reports like some of the others posted consist of basically anything IMPORTANT needed to know by the recieving nurse ex.

1)procedures done in emerg (xray, CT)

2) pending diagnostic tests

3) telemetry required, iv, is there iv antibiotics and which ones due at what time

4) brief hx of pt's condition and overall plan and most importantly DNR status

Anything else can be read by the floor nurses in the notes. We call up report to cardiology/Neuro and give verbal report to ICU. and there's nothing I hate more, then getting a call from the floor asking for the MARS sheet.

There's my two cents,

nursemoons14 · Dec 12, 2007

I work on an acute medical ward in the UK, when we get a patient admitted from the emergency department, we will get a call from the bed manager to let us know the name of the patient and check that we are ready for them.
The nurse from emgerncy department will then accompany the patient to our ward and give a verbal handover. i find this pretty good because I can ask any questions about the patient.

This may be effective in a small rural hospital but I know that in a busy 45 bed Emerg, this is not reality and would be impossible to bring up all pt's to every floor. ICU/Neuro ok, but would be very tough and time consuming for a large hospital.

brent_25, RN · Dec 12, 2007

I should have added to my last post that I work in a 60 bed ED in NYC. Trust me when I say we're busy - and in the last year I've only gave a written report ONCE! Every other time has been verbal handoff. It is the safest way to endorse patients. Patient safety always has to be #1 no matter how busy you are - sending a patient to a floor without anyone knowing is asking for trouble...

scattycarrot, BSN, RN · Dec 12, 2007

This may be effective in a small rural hospital but I know that in a busy 45 bed Emerg, this is not reality and would be impossible to bring up all pt's to every floor. ICU/Neuro ok, but would be very tough and time consuming for a large hospital.

I beg to differ. I have worked in a large inner city London hospital, with an ER which was always busy and we always transferred our own patients to the floor. Most hospitals in the Uk operate this way and it improves communication between the floor nurses and the ER. I must admit, that it is a pain at times but it ensures a safe and comprehensive handover is given. Sometimes with the more stable patients a CNA will do the transfer and the RN will phone the floor and give handover.