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.
If you don't call first and just show up to psych with the patient, you will politely be told to take the patient back to the unit they came from and call for further instructions.
There are good reasons for this:
1. We need to determine if the patient is appropriate for psych in the first place. They may be too medically unstable for us, or they may not really need psychiatric services. We're also not the dumping ground for difficult patients that you (general) may not want to deal with.
2. Patients aren't merely transferred to psych, they are admitted. So the nurse needs to get some basic information about the patient who they will be doing a full admission on.
3. We need to plan for the admission. Contrary to popular belief, nurses--even psych nurses--don't sit around all day playing cards. We're rather busy, even at night...on some units, especially at night. We can't drop everything because you show up at the door unannounced with a patient.
4. The bed that you thought was available for your patient may no longer be there. We may have had to move someone into a single room, close a bed due to isolation, make a room change, or transfer a current patient to a higher acuity bed. There's been a few times where nurses have called to give report on a pending admission and I've had to tell them, "I'm sorry, but something happened and that bed is gone now."
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.
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.
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.
I totally agree. You can't just show up with an ICU patient without giving report ahead of time. There may be numerous things that need to be set up before the patient arrives.
There is no reason not to call report for a patient going to any unit. If the nurse getting the patient can't get report, then ask if the charge can take report. Honestly you shouldn't have left until the other nurse was on the phone giving report.
Even with a rapid response patient going from the floor to ICU, I at least make sure the nurse caring for the patient is giving report to someone before I leave the unit. As long as report is in progress, then I will take the patient down to ICU.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I don't mind getting a bedside report when the patient arrives in ICU as long as I've received some sort of phone report to let me know they're coming in XX number of minutes. That phone report doesn't have to be long or detailed, but it is essential to know if they're going to need a ventilator, new drips and IV pumps because they're coming in with dopamine at 20 mcg in the standard strength and on the obscure pumps from the outside hospital, and which service do I need to page for orders.
One memorable day, I got a patient from an outside hospital on a balloon pump that they had to take apart partially to fit it on the helicopter (surprise!) at the same time as a patient came out of surgery from an aortic valve replacement. Both came while I was transferring my previous two patients to the floor, and the beds weren't clean, the ventilators and balloon pump weren't set up (or even called for), the drips weren't available, the suction set-ups weren't there (because someone else raided the room while I was transferring), the service wasn't aware of the patient and the rooms hadn't even been stripped from the previous patient. (Oh, and the cardiologist who accepted the balloon pump patient had forgotten to tell anyone that the patient was coming because he "knew there would be a bed because I'm transferring Mr. Wilson to the floor." Not how that works.). Patients are much safer sitting in the ER, the OR or the outside hospital's ICU than sitting in the hallway of our admittedly big time teaching hospital ICU waiting for the room to be cleaned.
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.
Amen! Our hospital is HUGE on bedside shift report, in which I'm a HUGE advocate. "Nothing about me without me."
However...we've transitioned to bedside shift report from the ER, which is great only in theory. An ICU room without a patient is a bed and gloves. The supplies I need to gather vary greatly from patient to patient.
Do I need one IV pump or two of the three-chamber pumps? Vent? RT on standby for A-line placement? Consequential Vigelio? Bags of 1L NS for boluses or just a 250 mL flush bag for antibiotics?
Just last week, the ER brought me a patient in 5-point restraints....um....that would have been nice to know beforehand. So as the nurse is giving an albeit terrible report, I'm struggling to replace leather restraints with our soft boundaries all whilst getting the patient on the monitor, collecting vitals, etc.
They call with report now, but give "official" report at the bedside.
I've had several septic patients especially go downhill and downhill FAST. If I need critical supplies nearby for my incoming critical patient, bedside report isn't going to cut it.
ERs get patients all day every day without a detailed report.
ICUs get rapid responses, often with a very scant report.
Even a patient in the ICU can have a rapid change in condition requiring extra pumps, pressors, restraints and god knows what else, set up on the fly.
Absolutely it is great for the ICU to customize the room and supplies ahead of time. But, critical care is best done in the ICU, and delaying that care can lead to poor outcomes.
The system of phone reports is the same system we used before computerized charting. In the 5 minutes it takes me to get to the ICU, the entire ER chart can be reviewed. And, if the patient is so critical I didn't have time to update the chart, they are probably too critical for me to play phone tag and engage in a lengthy conversation.
So- a phone report can be a great tool if used well- Receiving nurse reviews the chart first, and the only stuff covered is immediately relevant and not clearly documented. But, it's not necessary.
ERs get patients all day every day without a detailed report.
ICUs get rapid responses, often with a very scant report.
Even a patient in the ICU can have a rapid change in condition requiring extra pumps, pressors, restraints and god knows what else, set up on the fly.
Absolutely it is great for the ICU to customize the room and supplies ahead of time. But, critical care is best done in the ICU, and delaying that care can lead to poor outcomes.
The system of phone reports is the same system we used before computerized charting. In the 5 minutes it takes me to get to the ICU, the entire ER chart can be reviewed. And, if the patient is so critical I didn't have time to update the chart, they are probably too critical for me to play phone tag and engage in a lengthy conversation.
So- a phone report can be a great tool if used well- Receiving nurse reviews the chart first, and the only stuff covered is immediately relevant and not clearly documented. But, it's not necessary.
Really? I worked ER for many years. I've seen how ER charts--and I know that in EPIC--the charting system is different for ER vs. ICU.
Yeah. Right. The patient is literally so critical that 5 minutes from the ER is going to kill them on the spot.
then they are too unstable to transport to the ICU. They need to stay in the ER until at least stable enough to get into a #$##&(*% elevator.
That ticks me off. It's laziness plain and simple. There are people you can delegate that "5 minute task" to as well if it's just so critical for you as an RN to dash out the door. You can delegate it to your Charge RN---who---I assuming is aware of your hyper-critical-might die in the next 60 seconds patient?
When I worked ER---we got report from EMS (and I know this because I was EMS as well). You knew 5 minute to 5 hours prior to any bus pulling up.
This is a ridiculous comment---that ER's get patients without report "all the time"---you don't have triage at your hospital? Nobody takes a history before letting someone come through to the back?
I've had maybe a handful of patients that dropped in the ER waiting room---and that's a rare thing.
So this "ER just flies by the seat of their pants 24/7" is nonsense.
If that patient is so unstable that 5 minutes to give me "hey....dude is on all pressors needs a balloon pump now and is about to have his left arm amputated at bedside"---then he's too unstable to get into an elevator.
Just call report. Or have the sense God gave a goose and have your charge do it---since you don't work in a vacuum.
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.
I mostly agree with Muno here, generally if I know an admission is coming I have already looked them up. Half the time the nurse rolling the patient up didn't even take care of them so they are useless to me anyway. I do however get transfers to wait until we say we are ready, because if I am in a room doing CPR, or helping a doc during a sterile procedure, I won't be able to take the patient.
This is a ridiculous comment---that ER's get patients without report "all the time"---you don't have triage at your hospital? Nobody takes a history before letting someone come through to the back?
I've had maybe a handful of patients that dropped in the ER waiting room---and that's a rare thing.
So this "ER just flies by the seat of their pants 24/7" is nonsense.
We get patients with the bare minimum of information all the time. "Triage" either now consists of eyeballing and assigning ESI or simply assigning a room number for direct bedding. If someone does actually complete a partial triage in the EMR, then the way that is received is through reading it ourselves, not through a phone call or in person discussion. I'm not calling that good or bad, I'm just saying that whoever is in the back is taking all comers with very little notice and very little information. You know pt. care RNs are doing a lot of bedside/chairside/hall triage now, too, right? Traditional triage was taking too long to get patients from 'door to doc.'
EMS report is the usual, I agree - and is appreciated (although that report may make it to the responsible nurse with an essentially useless number of minutes' fair warning).
Anyway, all of that aside, here's the thing with the ED rushing people up to the floors/units. This is a CMS measure for the ED. It is most commonly not being done because of personal preference nor because we think we are "all that" and whoever is receiving the patient isn't.
It certainly is not my preference to leave all my other patients with no one truly watching them, so that I can undertake a 20 minute process (transport, wait for RN, bedside report) to do what takes 5 minutes (phone report).
So I don't disagree with the frustrations of those of you on the receiving end. I just think it's important that instead of infighting, we acknowledge the sources of some of the practices with which we disagree. We can be mad at the inconsiderate ED nurse, but the fact is that we are literally (actually literally ?) being timed on how fast that patient gets into a bed after someone decides they are being admitted.
That's the bottom line to all of this.
PS - In light of the comment I just made about safety on a different thread, I will add that my personal practice is to make sure a head's up is givenbefore I leave to bring a patient up. Most of the time I also ask if the person is all set or if a little time could help - because if it's something reasonable like "give me 10'" I have no problem with that.
JKL---I was ER for many years. There ain't no "infighting" or "mad at the ER" from me.
I was where you are. I transferred to ICU---and I attempt to be a "bridge" between the old ICU vs. ER attitude problems. I also tried to be a "bridge" between EMS and ER--and EMS and ICU.
I've worked Level 1s most of my career. 80+ bed ERs and 34+bed ICUs. The concept of "beyond unstable" is familiar on both ends.
However. If I had a patient in the ER that was bleeding out a hole in his side or I had to do chest compressions in the elevator in order to roll? I'm not rolling. I don't know about other ERs, but mine had some docs with some brains and common sense that said---this guy is going to die if we move him from here. Ergo---we had RRT as a permanent fixture in the ER, we had vents, Bipap, Aline, chest tube, etc---setups all there at our fingertips. We stabilized that patient prior to getting them to ICU.
There isn't an excuse for someone not calling a report. You don't have to do it personally---but if the situation is that critical---there are a hundred bodies around gawking that could help you out.
I just don't buy it--and I don't do it (not give report).
"Bare minimum" is NOT THE SAME as no report at all.
I agree bare minimum is what I usually got from EMS and gave when I was EMS. What do you need right now to save this patient's life?
But it'sinformation.
What the OP is asking is about not giving report at all and rolling up on a situation that may be lethal to the patient you are trying to save.
You come into my ICU while my 2 RRTs are coding two different patients at the same time? How about that? You think that doesn't happen? My docs are in the codes. A good portion of my crew is helping with them---runners, blood retrieval, etc.
And you---with your hair on fire because your patient "is going to die within 5 minutes" if you don't get them to my ICU?
What am I going to do now?
You have the facilities to keep an unstable patient in the ER until the ICU has at least one hand available to take them.
I know. I worked both. This is a "throughput" thing from the ER. I had 4 hours to get 'em up or get 'em out. Pick one. Or I got crap from my charge.
Too bad. These are humans. Not pieces of furniture that you rearrange because it's a numbers game. I call anybody out on being a crappy RN if they don't protect their patient from this type of garbage---you risk that patient's life for ridiculous reasons---you need to find another line of work.
The reasons for the bad blood between ICU and ER are manifest---the least of which is report. It was annoying to have an ICU RN ask me---is there any skin breakdown? Uh---well---I was far too busy with the sepsis protocol to really go over his skin with a microscope.
I've also been on the other end---ER give me "well---i am relieving the nurse who took care of this guy---he's been here for 7 hours---and well---I just don't know much but can I bring him anyway?"
What about relief nurse doing the extra 5 minutes and getting a little slip of paper with just the basics on it and call?
Seriously. It really does strike me that the person who is getting lost in all of this is the patient. Doesn't anybody get it that if communication breaks down that patients die?
I think that what the previous poster was referring to was the inordinate delays that have sometimes not been uncommon in the past. I don't think s/he was referring to a patient being the most unstable in the world and ergo they need to get to CCU stat and because of that there's no time for report. Probably more things like holding patients indefinitely or at least beyond necessity while people keep coming in the doors.
There are nurses who don't care/are selfish/unconcerned with others, etc. But more commonly I think people are in the patterns they are in because of decisions made at levels beyond the patient/primary nurse. Everyone is just under pressure. You have to have a little confidence and a bit of security (either within the workplace or outside of it) in order to be able to make your own decisions about where you personally draw the line on some of these things.
Really? I worked ER for many years. I've seen how ER charts--and I know that in EPIC--the charting system is different for ER vs. ICU.
Yeah. Right. The patient is literally so critical that 5 minutes from the ER is going to kill them on the spot.
then they are too unstable to transport to the ICU. They need to stay in the ER until at least stable enough to get into a #$##&(*% elevator.
That ticks me off. It's laziness plain and simple. There are people you can delegate that "5 minute task" to as well if it's just so critical for you as an RN to dash out the door. You can delegate it to your Charge RN---who---I assuming is aware of your hyper-critical-might die in the next 60 seconds patient?
When I worked ER---we got report from EMS (and I know this because I was EMS as well). You knew 5 minute to 5 hours prior to any bus pulling up.
This is a ridiculous comment---that ER's get patients without report "all the time"---you don't have triage at your hospital? Nobody takes a history before letting someone come through to the back?
I've had maybe a handful of patients that dropped in the ER waiting room---and that's a rare thing.
So this "ER just flies by the seat of their pants 24/7" is nonsense.
If that patient is so unstable that 5 minutes to give me "hey....dude is on all pressors needs a balloon pump now and is about to have his left arm amputated at bedside"---then he's too unstable to get into an elevator.
Just call report. Or have the sense God gave a goose and have your charge do it---since you don't work in a vacuum.
FWIW, my I am an ER nurse with a background in EMS as well as ICU experience.
In my hospital ICU does have access to our charts, (EPIC) and by the time they are admitted ,the ER doc has dictated. The ER doc dictation can be read in literally two minutes, and is incredibly informative.
And, not sure where you got the idea that I was saying that a 5 minute delay would kill the PT- reread my post, couldn't find it. Waiting five minutes for report would be fine, thanks for taking report so promptly.
As far as not getting report, I wasn't referring to triaged PTs. As an experienced ER nurse, you know that while you do get an EMS report, it is often pretty minimal, or you can actually hear the beeping of the backup alarm as they are reporting. Then you get a bedside report and deal with it. Maybe your ER was different.
So, really not sure where your reaction is coming from, but I hope you feel a bit better soon.
Meriwhen, ASN, BSN, MSN, RN
4 Articles; 7,907 Posts
If you don't call first and just show up to psych with the patient, you will politely be told to take the patient back to the unit they came from and call for further instructions.
There are good reasons for this:
1. We need to determine if the patient is appropriate for psych in the first place. They may be too medically unstable for us, or they may not really need psychiatric services. We're also not the dumping ground for difficult patients that you (general) may not want to deal with.
2. Patients aren't merely transferred to psych, they are admitted. So the nurse needs to get some basic information about the patient who they will be doing a full admission on.
3. We need to plan for the admission. Contrary to popular belief, nurses--even psych nurses--don't sit around all day playing cards. We're rather busy, even at night...on some units, especially at night. We can't drop everything because you show up at the door unannounced with a patient.
4. The bed that you thought was available for your patient may no longer be there. We may have had to move someone into a single room, close a bed due to isolation, make a room change, or transfer a current patient to a higher acuity bed. There's been a few times where nurses have called to give report on a pending admission and I've had to tell them, "I'm sorry, but something happened and that bed is gone now."