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

Nurses General Nursing

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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?

Specializes in ER.
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.

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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.

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Specializes in anesthesiology.
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....

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Specializes in Peds ED.
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.

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Specializes in ER.

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.

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Specializes in Med/Surg, LTACH, LTC, Home Health.

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.

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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.

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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.

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Specializes in oncology, MS/tele/stepdown.

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.

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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.

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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.

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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

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