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?
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.
When we get admits from the ER I receive a phone call from whoever the ER nurse is. I pull up the patient's chart on the computer while they go over the reason for admit, history, etc, and then we go over the chart together. Basically they will go over the bridging orders, written orders that aren't in the system yet, and diagnostics (and any results that are available). Then they say, "Any more questions?" Sometimes they'll miss something but it's no big deal since I can figure things out for myself. If there was any sort of miscommunication I can always call!
Usually after that a medical assistant or nursing aide will bring the patient up to me. Once in a great while the RN will come too; but I think it's on days when they're not busy and they feel like getting out of the ECC for a minute.
I can understand the gripes about nurses not being available for report, but generally I'll drop whatever I'm doing since it only takes a few minutes for report tops. We use an SBAR framework.
I don't work in CCU or anything like that, so generally we don't get patients that are in that bad of shape. They're usually fairly stable (although this isn't a 100% rule).
consulting physicians and whether they've seen them or not.
then.
why they came to ER and past medical history.
then.
labs and tests done with abnormals and outstanding tests and times due like troponins and FS
then.
current vitals, pain level and last pain med and time and medication and time given. At the end of the sheet the RN must sign with time and date. We used to fax...we have to call now...I'd like to go back to faxing. I always faxed current labs and er physician note for receiving nurse.
Something that may help you is making this paperwork part of the permanent record. I guarentee it will be filled out in its entirety!
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
i like the way you put things blee ;-) what helps me is when i have to float to er and i get an understanding of how information is gained, what paperwork to look out for when the patient transfers to the floor, and best of all get to know fellow staffers, furthering my appreciation of you guys, what you go through each night...simply phenomenal.
i do agree, with a holistic approach, where all of us see one another as a team everything works smoothly and no toes get bruised!
yes, i am the one who does request a stall of an ed patient to the floor. especially if i've just gotten report and i'm busily doing assessments and initial meds; thankfully, most times ed graciously honors my request!
We get a faxed report, then they call to see if the room is ready and if the nurse has any questions. They are permitted to bring the patient up after 30 minutes of faxing the report, but they'll work with us if they aren't busy and we are not ready.
Most of the time it works well. Our first version of the report was revised and it goes easier. Our ER is committed to having a thorough report, so as an educational opportunity I save the reports that give incomplete or incorrect information and the charge nurse from the ER handles it. Most of the time the reports are fine. This saves a lot of "the nurse can't come to the phone right now" and us having to drop what we are doing to get a verbal report.
I love faxed report. But it takes committment on both parts for it to work.
Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.
I work in a large teaching hospital, we get a ED summary that just comes off our main printer at some time, no nurse to nurse report in several years now, transport sends them up, on nights many times they just show up, booking never confirmed w/chg nurse,we have no unit secretary at night,( few units do,) I think the ED just thinks someone is sitting behind the desk waiting for them to spit out a booking off the computer-- they send pts up 20 minutes later, NO ONE is checking that printer, so----- suprise!!! The PACU is even worse, the unit sec gets a call when the pt hits the PACU , from then on in, it 's anyone's guess, 1,2,4 hrs later, NO report of any kind (Xyrs now), NADA, phone, printer ,nothing, pt shows up whenever, half the time you don't even know the procedure until after they're settled in the bed,(HIPPA) go find the paperwork just HORRIBLE oh yeh, then when they never show up we have to track them down to find out if they've been dc'd home or in the unit--just a tad different extreme:angryfire
Specializes in Psych, Med/Surg, Home Health, Oncology.
I work in a large teaching hospital. I work on a BUSY Med/Hem/Onc/Renal floor.
We get a faxed report. The report is actually a copy of the actual ER Chart. It is extremely comprehensive. It has EVERYTHING on it. History,
current complaint, a detailed system assessment by RN & MD, all procedures done & all meds given; also there are all lab results if available. We are all computerized so, we can also look things up.
Also everything is printed, so there isn't a problem reading handwriting.
It works very well for us; the only glitch is that every now & then, we get the patient before the report, or it gets accidentally faxed to the wrong floor.
However, on the whole, it's good for us.
When we first started this, we all complained & carried on that this system wouldn't work; we have been pleasantly surprised.
If there is any change, the nurse gives us an update call; also, usually the ER calls & askes if we got the report.
I work in a large teaching hospital, we get a ED summary that just comes off our main printer at some time, no nurse to nurse report in several years now, transport sends them up, on nights many times they just show up, booking never confirmed w/chg nurse,we have no unit secretary at night,( few units do,) I think the ED just thinks someone is sitting behind the desk waiting for them to spit out a booking off the computer-- they send pts up 20 minutes later, NO ONE is checking that printer, so----- suprise!!! The PACU is even worse, the unit sec gets a call when the pt hits the PACU , from then on in, it 's anyone's guess, 1,2,4 hrs later, NO report of any kind (Xyrs now), NADA, phone, printer ,nothing, pt shows up whenever, half the time you don't even know the procedure until after they're settled in the bed,(HIPPA) go find the paperwork just HORRIBLE oh yeh, then when they never show up we have to track them down to find out if they've been dc'd home or in the unit--just a tad different extreme:angryfire
A Joint Commission surveyor would have a heyday at your place. Review the 2008 National Patient Safety Goals, specifically #2 about "communication among caregivers".
2E: Implement a standardized approach to “hand off” communications, including an opportunity to ask and respond to questions.
A phone report is ALWAYS the best way to endorse a patient Brent.
Brent, at one time I would have agreed with you whole heartedly. Today we receive a printed report. Then follow up with a phone call to clarify anything and answer questions. Most of the time there is nothing. Occasionally there is only one thing that we have a question about so the call is quick and the problem is alway cleared up.
The printed report comes directly from everything in the ER record. So we know all the ER nurse knows and sometimes more. ER records are shorter than the chart they compile while on a floor so It is a quick read. (faster than listening to a nurse go on about antidotal stuff and more useful than a verbal that is too general.)
All the labs, VS, meds that were given. Treatment plans etc. everything the MD or nurse covered while in the ER is there in an easy to read print out.
Complete with how they looked on arrival and how they look now.
Hand written ER notes are not that complete or easy to read.
I work in a large teaching hospital, we get a ED summary that just comes off our main printer at some time, no nurse to nurse report in several years now, transport sends them up, on nights many times they just show up, booking never confirmed w/chg nurse,we have no unit secretary at night,( few units do,) I think the ED just thinks someone is sitting behind the desk waiting for them to spit out a booking off the computer-- they send pts up 20 minutes later, NO ONE is checking that printer, so----- suprise!!! The PACU is even worse, the unit sec gets a call when the pt hits the PACU , from then on in, it 's anyone's guess, 1,2,4 hrs later, NO report of any kind (Xyrs now), NADA, phone, printer ,nothing, pt shows up whenever, half the time you don't even know the procedure until after they're settled in the bed,(HIPPA) go find the paperwork just HORRIBLE oh yeh, then when they never show up we have to track them down to find out if they've been dc'd home or in the unit--just a tad different extreme:angryfire
thats why we have hte paging system, onc ewe send the fax up. we send a page and they either accept or decline the pt. but thats neither here nor there cause we send them up anyway. Its more safe sending a failure to thrive up to a medicine floor and waiting in the hall then have an acute MI waiting in the ambulance hall. thats just my point of view tho
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november17, ASN, RN
1 Article; 980 Posts
When we get admits from the ER I receive a phone call from whoever the ER nurse is. I pull up the patient's chart on the computer while they go over the reason for admit, history, etc, and then we go over the chart together. Basically they will go over the bridging orders, written orders that aren't in the system yet, and diagnostics (and any results that are available). Then they say, "Any more questions?" Sometimes they'll miss something but it's no big deal since I can figure things out for myself. If there was any sort of miscommunication I can always call!
Usually after that a medical assistant or nursing aide will bring the patient up to me. Once in a great while the RN will come too; but I think it's on days when they're not busy and they feel like getting out of the ECC for a minute.
I can understand the gripes about nurses not being available for report, but generally I'll drop whatever I'm doing since it only takes a few minutes for report tops. We use an SBAR framework.
I don't work in CCU or anything like that, so generally we don't get patients that are in that bad of shape. They're usually fairly stable (although this isn't a 100% rule).