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New protocol - No report from ER to floor...

justjRN specializes in med surg.

I work med surg and our hospital recently started new protocol that ER does not call report to floor patient is being admitted to. We are told we will be getting ER patient such and such and what they are generally being admitted for and to expect them within 10 minutes of notification they are coming. We are to look up any other info (our entire report basically). It sucks for us and it sucks for the poor patient who has questions etc when they get to the floor and we know nothing yet as it usually takes about a good 15 mins UNINTERRUPTED (which is nearly impossible as we are working short most times anyway)  at a computer looking up history, labs, notes ,iv's, meds given in ER, new orders etc to put together why they are there/plan. Many of us have complained how unsafe it is and even many near misses that have happened because of it. But of course.. it falls on deaf ears. I was told it's understandable but they don't see it changing anytime soon...?!  

So- I wanted to vent and to also see if this is the process anywhere else out there? 

OUxPhys specializes in Cardiology.

I have never seen this at any hospital I have worked for and it is extremely dangerous. It's already bad enough we have to deal with ER calling and sending patients right in the middle of a shift change. Unfortunately I see this new policy backfiring and who will get blamed? The nurses, so just make sure you guys CYA. 

They did that at a hospital where I did an ER  contract in April. It was a fast paced, high volume ER. 

For stepdown and ICU patients,  there still was a verbal report,  and the ER nurse brought the patient upstairs. 

Since there have been so many problems with push back and delayed report at my last job, I found it refreshing. The point of it is to keep the ER from getting backed up, which is also a huge safety concern.

I get your concerns totally though. From the ER point of view, if there is a delay in moving patients upstairs, that means you have sick people waiting in the waiting room. That would be the bigger picture. I would be interested to see some good studies of outcomes.

Is this legal?  I'd be calling state BON.  And when the patients get frustrated because you don't know the answer to their questions immediately say that you didn't get verbal report and you have to read everything and they're welcome to mention it on their comment card. 

The remedy is to get on the computer while in the patient's room. I am a big believer in doing charting in the room, when possible. It's good time management and allows you to spend more time with the patient.

While you're looking up orders and details from the ER visit, you can discuss the plan of care with the patient. Patients really appreciate being informed as much as possible, in language they understand.

That means, adapting your explanations to their level of education, and general intellectual ability. That's an awesome part of what we do, in my opinion. Nursing is truly an art.

canoehead specializes in ER.

I work in the ER and I think you should get an hours notice. JMHO.

Pixie.RN specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN.

Does your EMR generate some kind of SBAR summary that might be helpful? I never liked sending my patients out of the ED without speaking to a human. 

I worked at a hospital that used an SBAR report. When they assigned the room the charge nurse would get the patients name via pager. When the patient is ready to come up to the floor the charge nurse gets a notification that the SBAR is ready. They are to bring the patient up after 30 minutes when the SBAR is notified to be ready. This allows time to review SBAR and get ready. There are situations that require a nurse to call report. The only issue we deal with is often times we get notified SBAR is ready but the ER hold their patient until shift change. This has caused a lot of issues for the floor nurses and they are not allowed to admit patients during shift change 30 minutes before 30 minutes after.

10 hours ago, Elaine M said:

Is this legal?  I'd be calling state BON.  And when the patients get frustrated because you don't know the answer to their questions immediately say that you didn't get verbal report and you have to read everything and they're welcome to mention it on their comment card. 

How could this be illegal?

Regardless of whether it is frustrating or best practice, it is done with the big picture in mind.  The big picture is that this is a better choice than backing up the ER.  

Emergent made good points about good use of EMR.  As an ER nurse, one of the things I have noticed is that despite advances in record keeping, many units use the same type of communication I saw as a student in 2002.  A lot of verbal communication and handwriting.  This is not how modern industries keep track of critical information.

FWIW- I sometimes have to give report about a patient I know almost nothing about.  When this happens, I open the chart and essentially read a condensed version to the receiving nurse.  I am reading the same chart he or she can access.  it only takes a few minutes, and they don't seem to notice or mind.

It would have been great if rather than just dump this on you, your bosses had designed a training around how to safely take PTs without verbal report.  

3 hours ago, hherrn said:

How could this be illegal?

Regardless of whether it is frustrating or best practice, it is done with the big picture in mind.  The big picture is that this is a better choice than backing up the ER.  

Emergent made good points about good use of EMR.  As an ER nurse, one of the things I have noticed is that despite advances in record keeping, many units use the same type of communication I saw as a student in 2002.  A lot of verbal communication and handwriting.  This is not how modern industries keep track of critical information.

FWIW- I sometimes have to give report about a patient I know almost nothing about.  When this happens, I open the chart and essentially read a condensed version to the receiving nurse.  I am reading the same chart he or she can access.  it only takes a few minutes, and they don't seem to notice or mind.

It would have been great if rather than just dump this on you, your bosses had designed a training around how to safely take PTs without verbal report.  

I always thought you had to give some sort of report when transferring patients. Imo throwing a chart at someone when you being a patient to a floor isn't report.  It may prevent back up in an ER but I think there are better ways to do that.  

1 hour ago, Elaine M said:

I always thought you had to give some sort of report when transferring patients. Imo throwing a chart at someone when you being a patient to a floor isn't report.  It may prevent back up in an ER but I think there are better ways to do that.  

What ideas do you have to prevent back up in the ER?

On 7/4/2020 at 5:20 AM, hherrn said:

FWIW- I sometimes have to give report about a patient I know almost nothing about.  When this happens, I open the chart and essentially read a condensed version to the receiving nurse.  I am reading the same chart he or she can access.  it only takes a few minutes, and they don't seem to notice or mind.

This is an important point that nurses on the inpatient side of the hospital often don't understand.

In the emergency room there are a lot of different shifts, not just 7 to 7 ones. You could start out in one part of the emergency room, and then as other nurses come in for their 9 to 9 shifts, or 10 to 10 shifts, or 11 to 11 shifts etc, the nurse that started with the patient might be sent to a different part of the ER, to open up rooms for the midday rush.

So, it is very common for the nurse who is giving report to just be finishing up with the patient. Maybe they had the patient only half an hour.

Then, we will give report based on what we see in the computer, and learn from the nurse who did all the work on the patient. Because the mentality in the ER is different, often our reports are more minimal, since we are so used to starting from scratch anyways.

I have worked in patient as well so I know the other side of the story. A bigger deal is made of report.

I wish they taught some of these things in nursing school so different specialties could understand one another better. There are some distinct cultural differences between them in nursing.

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