No report Transfers?

[ptrol64]

My midwestern community hospital has recently started a "No Report Transfer" from the ED to the floors. We are notified that an ED patient has been assigned to our Med-Tele floor and we are given 15 minutes to prepare and look up info in the computer. An ED nurse will then call and ask if we have any questions. We can see labs and nurse's notes which in the ED are a slight narrative, and ED MD notes which give the most info. Occas the MD notes are not completed and therefore not viewable, which gives us minimal info regarding the patient's ED course. I understand that a great deal of patient satisfaction has to do with waiting times in the ED and being housed in the ED, no one is happy about that, but I am so worried about patient safety in this situation. We are allowed to ask questions regarding the patient before transfer, but I live in fear that in the haste to get patients out of the ED, patient placement will suffer. We have already had to call Rapid Responses when patients are sicker than they appear on paper. We have been told that being in the Midwest, we are in the last area of the country to implement this, that it is the future. My concern grows with every transfer, just waiting for a disaster. Have your hospitals implemented no report transfers, and how do I make the best of this? Thank you all!

[MunoRN, RN]

Interpretations vary somewhat by state, but in my state that's considered patient abandonment. The nurse handing off the patient is required to ensure the receiving nurse has both received and understood report prior to transferring the patient, if they don't do that then it's abandonment per the state BON. Assuming the receiving nurse has received and understood report just because you don't hear from them doesn't meet the requirement.

[JKL33]

The way to make the best of it is to try very hard to review the information and participate in the phone call. During the call you can get all the same information you did with the old process if what is available in the EMR is not clear or adequate.

In general, in order to talk to your managers/supervisors about concerns you have to understand why a change is taking place. In this case it might have a little to do with patient satisfaction, but a lot more to do with the fact that quality measures (CMS) for the ED involve throughput times; how fast we can move patients out of the ED. How long we take to get them upstairs after we decide they need to be admitted. So....I am not saying you are complaining (I completely understand your concern) but just know what you're up against.

When you participate in the phone call, try to garner the same type of understanding about your incoming patient as you would with the old process (before you were asked to look up information). Or, look at it this way: The only thing that has actually changed is that you are expected to review available information before having the report conversation, and all of it is expected to occur within a shorter time frame.

Ask your manager how the implementation of this change is being monitored, then utilize the processes available to register problems.

Side note: be aware that some places are so serious about their ED throughput numbers that they (upper admin, not the nurses) literally do not care if the patient gets to the floor and immediately needs a transfer to somewhere else or immediately needs additional urgent assessment.

Do your best. Plenty of ED nurses don't like this either and are willing to work together to cover the patient safety and legal/ethical nursing bases (which hospitals increasingly don't give a blank about). You should be receiving report. Being given a few minutes to look up information is not a proper hand-off by any prudent nurse's definition. So get the information you need and if all of this psychotic need for speed results in disaster call an RRT.

Sorry and good luck.