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

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by justjRN Member Nurse

Specializes in med surg. Has 15 years experience.

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Emergent, RN

Specializes in ER. Has 29 years experience. 2 Articles; 3,860 Posts

On 7/5/2020 at 9:57 PM, LovingLife123 said:

I’m sorry, but telling me I can get all my info from the chart is the biggest load of crap I’ve ever heard. Not one ED person charted on my patient’s ICD. Not one.

I get real tired of hearing crap from other depts about my unit. Everybody thinks we just sit around in the ICU all day and yuk it up. I’m sorry the ER is backed up, or you had to hold a patient in PACU a little longer. I’ve got 4 different departments clamoring for my one bed.

Am I not entitled to shove lunch down? Do I not get time to clean my room and set it up? I get so tired of ED and PACU getting crappy about things out of my control. And sorry, but the ED is terrible at charting and giving me any info on my patient. Good thing I didn’t send my patient to MRI with the lack of charting and info.

LOL, you used the word crap twice, and crappy once.

hherrn

2,439 Posts

On 7/5/2020 at 9:57 PM, LovingLife123 said:

I’m sorry, but telling me I can get all my info from the chart is the biggest load of crap I’ve ever heard. Not one ED person charted on my patient’s ICD. Not one.

I get real tired of hearing crap from other depts about my unit. Everybody thinks we just sit around in the ICU all day and yuk it up. I’m sorry the ER is backed up, or you had to hold a patient in PACU a little longer. I’ve got 4 different departments clamoring for my one bed.

Am I not entitled to shove lunch down? Do I not get time to clean my room and set it up? I get so tired of ED and PACU getting crappy about things out of my control. And sorry, but the ED is terrible at charting and giving me any info on my patient. Good thing I didn’t send my patient to MRI with the lack of charting and info.

Having nurses cross train and gain exposure to other units would mitigate many of these issues. Anybody who thinks the ICU is yuking it up should spend a little time balancing dromotropic vs chronotropic meds on a sedated PT.

Similarly, anybody who thinks that the different practices used in the ER represent some sort of global incompetence in the field, should spend a bit of time in the environment.

Talk to float nurses. They have a great perspective, and are always the easiest to deal with when PTs go from one environment to another.

When I am precepting, I have preceptees accompany admissions to help them gain some understanding of the process, and the mindset of floor/unit nurses.

murseman24, MSN, CRNA

Specializes in anesthesiology. 316 Posts

2 hours ago, hherrn said:

Anybody who thinks the ICU is yuking it up should spend a little time balancing dromotropic vs chronotropic meds on a sedated PT.

Really....

HiddencatBSN, BSN

Specializes in Peds ED. Has 11 years experience. 593 Posts

5 hours ago, LovingLife123 said:

I’m sorry, but telling me I can get all my info from the chart is the biggest load of crap I’ve ever heard. Not one ED person charted on my patient’s ICD. Not one.

I get real tired of hearing crap from other depts about my unit. Everybody thinks we just sit around in the ICU all day and yuk it up. I’m sorry the ER is backed up, or you had to hold a patient in PACU a little longer. I’ve got 4 different departments clamoring for my one bed.

Am I not entitled to shove lunch down? Do I not get time to clean my room and set it up? I get so tired of ED and PACU getting crappy about things out of my control. And sorry, but the ED is terrible at charting and giving me any info on my patient. Good thing I didn’t send my patient to MRI with the lack of charting and info.

I hate to break it to you but the ER nurse doesn’t have time to get the level of details on the patient that you want. That’s why they’re going to you, and why they need to get out of the ER asap.

Emergent, RN

Specializes in ER. Has 29 years experience. 2 Articles; 3,860 Posts

I've found that ICU nurses are generally better about researching patients ahead of time on the computer before I call for report. They are very detail oriented as a rule.

The hospital where I did the contract, that had this policy, still had phone report for ICU and stepdown patients, like I mentioned. It was only lower acuity patients that went up without verbal report.

This biggest problem for nurses on the general wards of course, is that they are juggling more patients, and lack the time for that detailed research. That's why opening up the computer in the room, while getting the patient settled and admitted, is such a vital tool.

NotMyProblem MSN, ASN, BSN, MSN, LPN, RN

Specializes in Med/Surg, LTACH, LTC, Home Health. Has 36 years experience. 2,690 Posts

My last three travel assignments (at three separate hospitals) had instituted a faxed-report procedure. The ER nurse would only call to say check your fax machine for information on Patient X.

I’m assuming this is the latest trend(???) of large facilities because my assignments were at level one trauma centers, one of which was at the facility of a very well-known burn center.

JKL33

6,090 Posts

8 hours ago, hherrn said:

In a perfect world, receiving RN would have an opportunity to review the chart- 5 minutes should do it. ER nurse could give a brief verbal presentation covering the big picture and nuanced issued not well covered in EMR. Receiving nurse could ask questions about issues not in the EMR.

^ Yes, this is the happy medium! You asked for my suggestions about the admit-decision-to-bed times, and that ^ is it. There's no (good) reason that it can't be accomplished. Remember, we can do all kinds of sheer craziness when the right people want to do it--this is nothing in comparison. If there is not enough help upstairs for nurses up there to easily accomplish this, that's a different problem. Well, I suspect it is the actual problem, period.

It is my belief that seeking to bypass these exact elements you mention (quoted) is about something other than backlogs and admit-decision-to-bed times.

My long-term view of the issue is that staffing has always been at the root of delays, but in the past there were a few nurses here and there who did make things even worse by intentionally delaying in taking report and thus further delayed the admission process. That seems like so long ago, though. You won't walk onto M/S these days and find nurses eating BON-bons instead of taking your report. And yet, here we are pretending that the delays are because lazy nurses and BON-bons, and that the solution is to cut out the report and send the patient up. Choosing a solution that pretends this is about lazy nurses is pure baloney these days. They are running their asses off just like we are downstairs.

What I do: Call the phone of the nurse getting the patient. Ask them kindly if they have a minute to take a brief report. Most times they do (or they don't but they take the report anyway), rarely/occasionally they ask to call me back in 2 minutes - and they do. They call me back, I give brief/concise report, ask if they have questions. Done. Send the patient up. I have found that when we respect others and actually act like we're all in this together, people respond in kind. I have almost zero trouble giving report. I am about what is good for patients and good for nurses, I don't give a flying fig about administration's fantasies and I will never begrudge another nurse for not being able to perfectly clean up the messes those fantasies cause.

Edited by JKL33

I worked in a hospital that did this. STEMIs ended up coming up to the floor. Nurses would find patients in rooms and not even know they were coming or who they were or how long they had been there. It lasted about 6 weeks.

Edited by egg122 NP

Swellz

Specializes in oncology, MS/tele/stepdown. Has 6 years experience. 746 Posts

I wish we still got report. If the ED calls and the receiving nurse is busy, the charge nurse should take report. If the charge nurse is busy then send up the patient. Get names and put that in a quick note to hold people accountable. I'd like to think that would work.

My first job we had to receive report before the patient could leave the ED, and it caused a backup in the ED because we'd be too busy (or say we were), so I understand why these changes were made in many hospitals. At my current health system, we occasionally get a call with a baseline neuro status if someone comes in with a neuro complaint, but for the most part we get nothing. It's not my favorite thing.

Edited by Swellz
addition

We started this protocol last year and many people weren’t excited about it, they had lots of safety concerns. We quickly became accustomed to the flow of it, and you find that you learned more from your chart than you would from the verbal pass off ( they’re swamped down there and don’t know much more than you). I will say this, they should give more “call to transfer” time, we get 20 minutes (usually turns to 30). Ten minutes isn’t very fair when you’re in the thick of things.

As others mentioned, give it an honest try, then critique it. In time you all can help smooth the process.

LovingLife123

1,532 Posts

On 7/6/2020 at 3:04 AM, HiddencatBSN said:

I hate to break it to you but the ER nurse doesn’t have time to get the level of details on the patient that you want. That’s why they’re going to you, and why they need to get out of the ER asap.

I don’t need every, single detail. But the patient having a implanted defibrillator is important. My point was, it wasn’t in any note. So you all saying look in the notes in crap, because there is nothing in the notes.

The ER getting crappy because I’m transporting a patient to their new room to make room for the patient from the ER is unacceptable. I can’t make floor beds open up faster, I can’t make housekeeping clean the room faster.

I don’t give a crap when their last BM was, what their skin looks like, any of that small stuff. But I want a basic report. Don’t tell me the ER doesn’t have time. I’ve gotten a lunch break twice in the last two weeks. I don’t have time.

simba and mufasa

Has 18 years experience. 5 Articles; 59 Posts

Crowding, Boarding, and Patient Throughput

ER is a catchment area, get patient, stabilize and move them out. An ER is not a holding area, and nurses do not have time to take care of the patient as done on MedSerg/ICU or any other area. Throughput is the name of the game. Working as an ER nurse has opened my eyes literally and figuratively. The constant push of report by nurses on the receiving units can be detrimental to the patient. An emergency department (ER) is “crowded” when the need for services exceeds the department’s available resources for timely patient care. I understand that nurses on the receiving floors are frustrated.

Crowding causes a variety of deleterious patient care and outcomes, including increased patient mortality, increased rates of medical errors, increased numbers of delayed or missed orders, increased total length of stay, decreased door-to-imaging times for stroke patients, poorer outcomes increasing ambulance diversion (I.e., when an ED closes to ambulance traffic) and patient offload time (I.e., the time that EMTs and paramedics spend waiting for an ED bed to open so that they can return to services. Have been there done that. I have been on the receiving end and have sabotaged a transfer at times but the caseload on the units is real, its a slippery slope, profits before safety and a hostage situation for nurses where they are left bickering at each other instead of administration that directs everything with a remote control. Form a nurse practice council so self governance and autonomy.

And yes, have called the floor for report without fully knowing the patient. if the patient is septic, who cares about the skin, as an ER nurse, the concern is to stabilize and ship them to the unit. and then the full assessment can be done.

Dr Madenya