Is it necessary to call report before transferring care of a patient?

[C.diff Aint Sexy]

Hi all,

Why do we call report to nurses receiving patients, before we transfer them? Is it okay to give a bedside report when we transfer patients, without first calling the nurse?

Here's the background: I work in a procedural area. We always call report before transferring a patient back to their room. Recently we had an outpatient develop complications and require a transfer to ICU. The person who was monitoring the procedure called the nurse to give report, while I transferred the patient to ICU. When I got there, it took awhile for the nurse to come to the room. She told me she didn't know anything about the patient, and didn't know she was getting a patient until that moment. I gave her a bedside report (from what I remembered about the procedure and patient). When I followed up with my colleague, he said he tried to call twice and couldn't get a hold of the nurse because she was in another patient room, so the nurse would get bedside report when the patient arrived. I became frustrated because I feel the nurse should be notified and receive some kind of report before the patient arrives to their room.

When I brought it up to my supervisor, she said my coworker attempted to call a couple of times, but couldn't reach the nurse. She then said there shouldn't be a problem with giving bedside report, instead of report over the phone. (My supervisor is not an RN).

I trained in ICU and never got patients without getting some kind of notification over the phone -i.e. rapid response, or pacu....is it just me? Is it okay to get the first report about a patient, as they're wheeling them into the room? I'm just confused. It feels wrong, but I don't know if it's just my perspective.

[canoehead, BSN, RN]

If you don't know the patient well, tell her what you know, and ask her to call the sending unit for more details. You can offer to stay with the patient for five minutes while she's on the phone getting the rest of report from your coworker.

[HomeBound]

The ICU is a different beast. If this pt meets the criteria for that level of care, certain things have to be in place before a pt can be safely transferred. The least of which---is the RN that is assigned this pt even available to drop what he/she is doing in order to run through what could possibly be a critical admit?

The room has to be set up for this particular pt--our ICU doesn't have everything needed because it's an infection control issue--we only bring in supplies when a pt is on their way, and only what is needed for that particular case. A Post Op pt is very different and has different needs (vent? RRT? CXR? special procedure? Aline or CVP or swan? drips?) than an ER pt with a closed head injury.

I need to know. Bedside report is far too late for me to set up what that pt may need in order to act quickly if that pt is completely unstable.

I have had to roll on a hem-onc unit with an ER pt who was "pre admitted" and was required to stop at the ER for a port access and some ABX. I called twice---each time being told "call back in 15 minutes, the RN is in another room". The third time I called--I asked for the RN Mgr. I was told she was "off the floor". I asked for ANY nurse on the floor and was told.....drum roll please....

They are all off the floor at Starbucks and will be back in 15 minutes.

I documented that response so thoroughly that within 2 minutes---I got a call from Hem-Onc RN who was supposedly "in another patient's room which means she's really at Starbucks"---railing at me for "unprofessional behavior" and demanded I delete the note.

Nope. You act like that? You get burned. She tried to suck up to me on arrival saying that she and her compatriots were "trying to make a point to the RN Mgr" that they should not have new admits after a certain hour.

Oh. Well. Not. My. Problem.

ICU level care is called critical care for a reason. I am 1:1 for a reason. That person may likely be clinging to life by a thread---and I am not going to allow anyone to roll up when that patient can suffer from the delay in care because you don't want to wait a hot minute while I duff my stuff from my c.diff patient's care.

Worked at a place that I was slammed for giving report to the ICUs from the ER. "DON'T TEACH THEM THAT WE WILL DO THAT!". Too bad. I did it anyway. If that pt is so sick that they need ICU? I am giving that RN the chance to have a smooth handoff---and my patient doesn't crash while they're grabbing a vent.

Act like professionals. These are people---not inanimate objects that are being sold at a yard sale.

Sorry OP---this is a sore spot with me. I would never do it to another nurse--put them in a position that would compromise care---and I would never put my patients in that position, where their care could be compromised.

Just call report.

[JBMmom, MSN, NP]

I can't see many instances where a report ahead of the transfer would not be feasible. I know that when people come into our ICU, as was already mentioned, room setup takes a few minutes and requires a heads up. Even when I'm transferring out of the unit to step down or a floor bed, it seems safest and most considerate to give a full report by phone when the nurse can have a minute to put her head into report. Bedside updates are great, but some nurses need to write things down and organize the information, and at bedside they would be unable to do so.

[LovingLife123]

I think it is totally crappy to not get report first. I’ve had that happen to me a couple of times and I was so ticked off I could barely hear what the bedside report was.

Very rarely have I not been able to get report when it’s called. If for some odd reason I am not able to, either a coworker has or my charge has.

I always like to make sure my room is set up. Do I need respiratory there or on standby? Do I need a physician at bedside?

In that short 10 minutes before I receive a patient, I get all of my ducks in a row as I am preparing for everything. Time is of the essence in the ICU.

I disagree completely with blindsiding a nurse. While I understand the situation, report should have then been attempted to the charge nurse before just bringing the patient up.

[JKL33]

3 hours ago, C.diff ain’t sexy said:

I became frustrated because I feel the nurse should be notified and receive some kind of report before the patient arrives to their room.

Not trying to be dumb here but clearly there was the potential for what you describe - it's pretty common to not be able to give report on the first phone call.

So if you know this is a possibility and you know that you feel strongly about it, why not wait until you know phone report has been given before beginning the transfer? It doesn't take long to move a patient from one place to another, so chances are that even if you didn't set off until you knew your colleague was beginning to give report, you'd still get to the bedside before the nurse had time to hang up the phone, let alone prepare for the patient's arrival....

If you were already gone from PACU/recovery, what preferable thing should your partner have done? Or were you under the impression that report had already been given before you left? Sorry if I've misunderstood.

Beyond this scenario, the general topic of bedside admit report involves the same principles as regular bedside shift report. These decisions are made regardless of staff concern; they want patients to be involved in the hand-off whenever possible, they want the patients to see teamwork, and, of course, not playing phone tag for 20-30 mins is simply more efficient.

[C.diff Aint Sexy]

32 minutes ago, JKL33 said:

you'd still get to the bedside before the nurse had time to hang up the phone, let alone prepare for the patient's arrival....

If you were already gone from PACU/recovery, what preferable thing should your partner have done? Or were you under the impression that report had already been given before you left? Sorry if I've misunderstood.

You bring up a great point about the timeliness of the transfer. I thought report had already been given when we were getting ready to go to ICU. I asked to confirm, and my colleague said he was calling. When he wasn’t able to make contact, he left for the day, and my supervisor backed him by saying it was okay to give report at the bedside.

In hindsight, I should have waited until I saw that he followed through. At my facility, ICU patients bypass recovery and go straight to ICU, but we still give report before transferring the patient. This way, we’re all on the same page when the patient arrives.

To me, it’s not only considerate, but also ensures patient safety for the incoming patient, and the nurse’s other patient(s). The people who are making these decisions have no bedside experience and aren’t nurses (it pains me to say). I hope to enlighten them so we can prevent harm to patients. Thank you all for your input!!! It’s been truly invaluable to me!!!!

[MunoRN, RN]

I work in the ICU and I personally don't mind having a patient just show up from somewhere, typically there better off in the ICU with a surprised ICU nurse than staying longer where they were. It should be noted however that there are all different kinds of ICU nurses.

It hasn't been an unusual rule where I work to have the '2 call attempts then we're coming anyway' rule, if the nurse giving report has made 2 failed attempts to reach the nurse by phone, then they bring the patient and do a bedside handoff.

[RNperdiem, RN]

If you can't get a nurse on the phone, it is probably for good reason. The nurse might be off in MRI with their other patient and not even be aware that they have been assigned another one. Or another patient is coding and they can't come to the phone right now.

This is where you ask for the charge nurse and give them the report. At least that way someone can notify the respiratory therapist, get the room ready.

[Swellz]

It should be every time it can be. The nurse should have tried to get someone else, like the charge, to take report.

I wish the ED gave report to the floor, but it's not policy at the hospitals I work at now unfortunately. I do sometimes get a call for a neuro admission with a baseline neuro status. It's just better for patient care, and every other nurse to nurse handoff requires report. But letting the floor dictate when a patient transfer happens wasn't a good system either, so I understand why things changed. I just think there was a solution in the middle (like charge nurses taking report if the floor nurse is busy) that was skipped over for efficiency.

[OyWithThePoodles, RN]

Anytime I've transferred a pt to ICU from my floor (surgical) it's been because my patient was crashing. House notifies the unit that we are coming, and coming NOW. They don't talk directly to the receiving nurse, likely the unit clerk, and tell them the original dx and why we are now on our way.

I stay and help get things as under control as possible, meanwhile the receiving nurse and usually a couple others are in the room helping as well. I will give a verbal report on what went down, the important things that I think they need to know immediately, then I have them call me for report later. It's always worked, and never been an issue, at least if it was I have never been told.

ETA: Waiting to call report in many of my transfer cases could have been detrimental to the patient, time is money... well, life.

[MelEpiRN]

Second OyWithThePoodles. It sucks, but sometimes we get minimal notice the patient needs an ICU bed and the nurse just doesn't have the opportunity to call/ reach the ICU nurse taking the patient. I don't like it, but sometimes it happens because that patient needs to get to the ICU STAT.