No More ED Report?

[FarmerFNP]

So a couple of days ago out ER director told the directors on the floor that the ED nurses will no longer be giving report when they send us patients. True to their word, I received two admission from the ED with no report. They now send us an ED flow sheet which basically just has the patient's name, visit reason, and most recent vitals, as well as nurses notes if they have been entered (mostly the notes are "Reported off to so-and-so, RN).

We are all pretty upset about this. I work on a busy med tele floor and half the time we don't even know we're getting a new patient until were receiving report, at which point we can get ready to get the new patient. Now we really don't know anything until after we have received the patient. I understand the reason for it as it helps move patients from the ED faster, but it's causing a lot of concern for the floor nursing staff.

So basically, I just wanted to get other nurses' thoughts on this. Any input is appreciated!

[RedInScrubs, ASN, RN]

No report given or hand off is SO dangerous in the continuity of care keeps patients safe. I once received a hypoglycemic patient from the ER without report, and by the time I realized they were on the floor, their glucose was below 50 because they'd been sitting in the room for a half hour before I even knew they were coming. I called down to the ER and talked to the charge, because that was a near miss incident, and could have had some SERIOUS repercussions to the patient.

I would be reporting that to someone on a board position, because that's just asking for mistakes to happen that will lead to patient harm.

[DatMurse]

Wow that sucks.

Honestly at my facility the ED might as well not give report b/c they are horrible and give inaccurate information all the time. For example, I've gotten things in report from pt's BP was 125/64....15 mins later upon the pt entering my unit its 218/102 to being told if pt can ambulate to restroom and pt comes to room and is paraplegic and has a suprabupic cath. The other nurses and I just take it with a grain of salt, and trust nothing they say which sucks b/c it's your colleagues. Now, on our unit we do get a TON of direct admits straight from doctor's office in which you get NO report. Just a little sheet from the doctor stating diagnosis and orders. It's not too bad. It's a little more time consuming though.

Good luck with everything though!

Patient is up and ad lib. comes in and the pt hasnt walked for 10 years.

happened to me before.

I also asked if the patient was yellow,(jaundiced). They said they havent seen them. -_-

As an ED nurse, I can say sometimes it can take hours to get a receiving RN for verbal report. In the case a nurse is unavailable, we send written report, but it has more than recent VS, it includes CC, PMH, Systems assessment, labs, meds received, radiology, etc. It's not as good as verbal report, which I believe to be superior, but I feel a lot safer sending that up. With a good EMR, though, one can access most of these records.

So maybe there is a reason they cannot get report for hours?

[WoosahRN, MSN, RN]

At one point they tried to change stuff in my hospital. It was when I was on general floor vs ICU, so I'm not sure how they handled the ICU report at the time. But the new rule was that ER would fax an SBAR report sheet and then would call the unit to speak to the nurse and ask them if they had questions. It didn't make sense given that once they called us, we of course we ended up asking questions that weren't covered. "How do they look now"?

Anyway, I don't think it lasted very long at all.

[Alicat1451]

I was getting verbal report from the ED the other day and the nurse mentioned the patient was on precautions, and I realized she was going into a double room. It wouldn't have been a good thing to come up to the floor and then realize we couldn't take the patient because we didn't have any private rooms. I guess it would be in the system as well but we at least know the patient's not coming up to the floor until we hear from the ED nurse by phone. And yes, this probably should have been caught by admitting :)

[RedInScrubs, ASN, RN]

I was getting verbal report from the ED the other day and the nurse mentioned the patient was on precautions, and I realized she was going into a double room. It wouldn't have been a good thing to come up to the floor and then realize we couldn't take the patient because we didn't have any private rooms. I guess it would be in the system as well but we at least know the patient's not coming up to the floor until we hear from the ED nurse by phone. And yes, this probably should have been caught by admitting :)

Sometimes I wonder about admitting.. Ours didn't catch the same problem for us, but ED didn't either, because our ED doesn't have access to past patient records once they're inpatients. We had ONE bed open on the entire floor, which happened to be a double, and the patient came up with a history of positive VRE in the last month. I didn't catch that until I opened her clinical data to start the admission and the isolation protocol populated automatically from her previous visit. While she was already in the room, and had been for about 45 minutes. Super fabulous switching occurred in the next hour, and good times weren't really had by all, can't lie.

[greenerpastures]

Our hospital doesn't do ER report most of the time. Occasionally, someone will call report, but in general, we're just supposed to review the 4 different scanned computer documents to find out about H&P, Meds, IV, Admit reason, ER Admission SBAR to get our information. I would much rather someone call report to me as it's much easier to get a 5 minute call and ask my questions than it is to read through these multi page documents that freeze the screen. As a side note, I think all hospitals should have a protocol that transfers from the ER to the floor shouldn't be allowed from 645-745. I can't tell you how many times we get admissions in the middle of report.

[psu_213, BSN, RN]

I would question the ER nursing director being able to make a change like that on her own without the rest of the hospital input.

At my previous job I worked on a tele unit. It was not the ER NM who made such a change…it was the charge nurse that shift who made the change--without announcing it to the rest of the hospital! Needless to say, we were caught a bit off guard when a patient just showed up.

As an ER nurse now (in a different hospital) I can't imagine sending a patient up without giving report.

[psu_213, BSN, RN]

There have been many times to were I had to rapid response a patient as soon as the came up from ER.

I think part of this is due to a misunderstanding of what each considers a "get help right away" issue. For example, in the ED, BP 172/94 (asymptomatic)...yawn. Yet I know a floors calling a rapid response for such a pressure, even when asymptomatic. On the other hand, I think the ED nurses sometimes forget that most floors don't have the luxury of a doc "right there" to handle issues like we do in the ED. Unfortunately, it leads to unnecessary tensions between the floor in the ED.

[psu_213, BSN, RN]

I also asked if the patient was yellow,(jaundiced). They said they havent seen them. -_-

Part of the issue here may be...when the ED gets really busy, the nurse who took care of that patient may not be able to call report. He/she might be tied up in an arrest, or busy with 5 other patients, so the charge (or other RN) will then call report.

[Momma1RN, MSN, RN, APRN]

So I read this a while ago and thought it was nuts. Then, my facility started doing this as well. They fax us a "report" aka they print out their EMR (which is a different format than what we use on the floors) and fax it to us. If we have questions we're supposed to call. Apparently, it's all in preparation for our EPIC implementation that is coming up.

[delphine22]

Had a few diff experiences with this.

Hospital A, faxes an SBAR, usually a little incomplete. Then the nurse will call to see "if we got it." I will take that time to jump on the phone and ask any questions I need. If I haven't had time to read it by then, tough, I MAKE time (or skim it on the phone with them), otherwise I'll get a nasty surprise. I understand the reasoning: When there's a dispo, JCAHO (or CMS, I forget who) mandates 30 minutes to transfer, or they fall out on some core measure or other. They can't wait for us to be free to come to the phone.

Hospital B, the floor: Called report from the ED. However, I've often come on to my shift and gotten report from the nurse who also just got onto her shift, and has maybe glanced at this pt, but certainly not assessed them. Also, if the ED calls during change of shift, we are to STOP our bedside handoff reports currently in progress to take the ED's call. Incidental overtime be damned, the nurse in front of me must wait.

Hospital B, the unit: In-person report when the pt is delivered. We get the name and dx over a pager, so I make sure to stop and check the orders/labs before the pt gets here, which will cut down on the "did you draw blood cx or should I?" questions. I hate this though, because between the stretcher and the bed and the million people who show up to help settle a new pt to the unit, I always end up getting report outside the room, at least 10 feet away from the pt. I wish I had report before they arrive, so I could spend my first few moments with the pt actually looking at them.

[ParalyticAgent]

As a side note, I think all hospitals should have a protocol that transfers from the ER to the floor shouldn't be allowed from 645-745. I can't tell you how many times we get admissions in the middle of report.

Can you stop the flow of ambulances and patients walking in, as well?