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 Surgical Intensive Care.

I work on a progressive care unit (really just a med-surg unit tbh) where we also don't receive report from the ED. Is it ideal, absolutely not. It often leaves several gaps and unanswered questions. There have been times where most of the notes are "ambulated pt to the bathroom" or "pt to CT," which isn't exactly the most helpful. However, it has still worked out on our unit for the most part. I work as both floor and charge nurse, and by the time I get the page that the pt is assigned to a room, there is generally enough in the chart to gauge whether the pt is appropriate for the unit. We also receive three separate pages. One when the pt is pending into the unit, one when they are actually assigned to a room, and one which pretty much tells us to expect the pt on the unit within the next 20/30 min. Now of course the system isn't perfect. There have been times when we have had to quickly transport a pt to one of the ICU or step-down units, but it has been pretty rare in my experience. That being said, there are several factors at play so what works at my particular hospital isn't exactly applicable everywhere. Just sharing my personal experience.

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On 7/7/2020 at 4:35 AM, OUxPhys said:

So for those saying just read the chart why don't we do that for every area? Why should the ER only get that privelege? When Im busy id love to tell cath lab or one of the medicine floors "In slammed over here, just read the chart in the room".

My answer to this is that the ED has some unique features. For one, the ED is the only department that can’t say no to incoming patients. Boarding patients don’t get the attention they need because the ED doesn’t have the resources to care for such patients. ED order sets only include initial interventions. Continuing care is ordered by the admitting physician and should be carried out by the floor. ED nurses get their initial assessment, triage, and interventions done. After that, they have to move on to the next patient. If they don’t, patients can go completely unseen. In the ED, patients are being seen by a healthcare professional for the very first time. Patients that need immediate care, can potentially sit in the waiting room waiting for nurse availability. There is lots of data that supports that patient boarding is very bad for outcomes.

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Specializes in Nurse Attorney.

The nursing board does not have any jurisdiction over organizational policies and do not get involved with labor management issues.

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Specializes in Emergency medicine, primary care.

We use EPIC at work and we only call report to the unit when patient is going to step down or ICU, and then the RN brings them up on a monitor with a tech. Otherwise, our department has a quick text template that we use as a free text note that looks like this:

Chief complaint, current signs/symptoms, mental status, precautions, ambulatory status, outstanding orders, current infusions, code sepsis y/n, other info (why they’re being admitted, IV access, other pertinent info), my contact name and number. So the floor nurse can pull it up quickly.

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Specializes in ED, Tele, MedSurg, ADN, Outpatient, LTC, Peds.
16 hours ago, JKL33 said:

This is seriously more time than I usually spend in total on the verbal report process.

Some of the stuff you're writing down is both inconsequential and very obvious upon first glance (NG, foley, location of IV site, ostomies, etc)

I promise I'm not picking on you!! - but <groan>. This is terrible, terrible. Filling out another piece of paper with stuff that is in the chart is the 2nd worst solution ("look in the chart 'cause they're coming up!" being the 1st worst solution). Actually, writing out another paper just might be worse than telling them to look in the chart. Sorry...?

I found it better than holding for report for half hour waiting time---! I didn't have that kind of time to spare.

I didn't find it tedious and honestly it took me way less time than that. It was easy to refer to if the floor called back. In case someone was covering me for break it would take that nurse a bit more time. The more you did, the faster you got! LOL!

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The name of the game has always been to get the patient out of ER stat.

I developed a report sheet that came with the patient , with the highlights of care given.

It was much safer for the patient, no push back from ER. A little report is better than no report.

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On 7/3/2020 at 8:02 AM, justjRN said:

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?

Our hospital started something similar but not as bad - only 10 minutes notice but nothing official about no report, but still, many ER nurses bring the patient to the floor without calling report. Very bad situation, I agree.

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Go public with this information by going to local media. The public has a right to know this is happening.

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1 hour ago, DeeAngel said:

Go public with this information by going to local media. The public has a right to know this is happening.

Why? This is SOP in many places. It can work if all parties play well together.

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Specializes in Rapid Response/Critical Care/CCRN.

I am a Rapid Response RN @ a large, acute care, level I hospital >700 beds that has been doing this NO ED Report practice for several years. The floor gets faxed or called a 15min. heads up, no info, just that they are heading out, then regardless of what's happening on the unit, the patient is brought. I would love to say gets better, but It stinks! After several years, ( 3 least,) it is still unsafe. The majority of our calls start with...…"I just got this one up from the ED...…"

Even though we have reported & documented events, it seems to be all about thorough put & clearing the ED.

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Specializes in Peds ED.
8 hours ago, DeeAngel said:

Go public with this information by going to local media. The public has a right to know this is happening.

The Public thinks that when their doctor tells them to go to the ER and that The Specialist will be waiting for them or tell the patient that “they called ahead” that they have a scheduled reservation so I’m not really sure they are qualified to evaluate this policy, but hey, add it to the Press Ganeys.

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Specializes in Dialysis.
On 7/3/2020 at 7:56 PM, Emergent said:

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.

The local hospitals in the area where I live don't have computers in the rooms, and are not allowed to take the ones on carts into rooms. The scanners for bands are wireless, so they don't need to. This would really suck in the cases here

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