Patient Handoff between ED and Inpatient units

[ejmRN]

Hello Everyone this is my first post!

I am trying to make a change in my hospital. I work at a 56 bed hospital and I work on a med-surg unit. Currently when we admit patients from the ED , the ED RN writes a SBAR note in the Electronic record and the Inpatient RN reads it and gives them the bed number. We have run into many patient safety issues.

So What I would like to know from you guys is 1. where do you work 2. What type of handoffs to you get from the ED? is it verbal or not? 3. last who transports the patient to the inpatient room? is it the RN or a ED tech?

Thanks so much for taking your time to answer! I am trying to get as many examples from as many hospitals nationwide as possible.

[Wuzzie]

43 bed ED. Average daily census 360+. App. 300 bed suburban hospital with open heart capability. ED nurse attempts to call report. If nurse not available they are given 15 minutes to call back or have a designee call. Barring a known emergency on the admitting unit if they don't call then report is written out on an SBAR formatted report sheet, floor is notified that the patient is coming up and patient is transported. Non-monitored patients transported by tech, stable monitored patients by medic, Critical care unit patients or otherwise potentially unstable transported by RN.

[MunoRN, RN]

You're looking for the holy grail of nursing; how to design a report system that makes everyone happy, so just remember to keep your expectations low.

I've worked places where we (in the ED) provide only a written report, it's not a method I particularly like, although on the receiving end I don't particularly mind it since the verbal portion often ends up being a waste of time. This is really more of a problem of crappy nursing than it is the format. We used the Nursing Process rather than SBAR, since SBAR isn't appropriate for a full report, it's only intended to communicate a single limited alteration of the overall plan.

In my current state, all handoffs must include a verbal component otherwise it is considered patient abandonment. We make an initial call to the receiving unit, most likely they are in the middle of something so we typically leave a callback number but a return call generally needs to be the next task on their list. If there is a delay then we bring the patient up and physically track down the nurse and give them a bedside report. All continuously monitored patients are transported by an RN, other patients are transport by techs usually.

[ejmRN]

Do you mind me asking what hospitals or city you guys work in?

[Wuzzie]

Do you mind me asking what hospitals or city you guys work in?

I don't mind you asking but the answer is no. One of the beauties of being on a forum is the relative anonymity. The data you need is ED size, average daily census, trauma level if there is one ( anything less than level 2 is irrelevant) and number of beds in the hospital.

[Wuzzie]

We used the Nursing Process rather than SBAR, since SBAR isn't appropriate for a full report, it's only intended to communicate a single limited alteration of the overall plan.

The Nursing Process?!! You mean you get to use that bastion of common sense that doesn't require a fancy acronym thought up by some ad flunkie? The one that actually works???? Lucky you!! But to be clear. If there was anything funky about the patient, no matter how stable, I did my darndest to actually talk to at least the charge nurse if the admitting nurse was truly busy. My SBAR reports were practically written in APA format!!

[SouthpawRN]

I actually just asked at how this process worked at the hospital I am doing my clinicals at. With EMR everything is available in EPIC, The nurse would make a progress note of who she talked to (there is also a specific spot in the EMR for the nurse's name), But for regular floors, a report is called up to the floor nurse, she has 20 minutes to respond, If no response, the report is given to the charge nurse on that floor. For ICU, the ICU nurse comes down to get the patient and get an in person verbal report. This is in an 800+ bed hospital.

[kataraang, BSN]

ED calls up to floor RN. They share the basics like orientation, fall risk, oxygen, fluids. Then the ED nurse brings the patient up and gives bedside report. This is in a 30 bed telemetry.

[1RNlife]

33 bed ED, 100 bed suburban hospital. I work on a 36-bed M/S/Tele floor. We are usually assigned to 6 patients, sometimes 7.

The ED only has to call report on "hold" patients, and not on patients that were not hold patients. Does anyone know why this is? If a patient was not a hold patient, we get a "10-minute warning" that the patient is coming up, but no report. However I have had hold patients come up without any report as well, and usually don't have the time to check beforehand if they were a hold or not.

There are always patients sent up at change of shift (for me, 3 pm) while I am trying to receive shift change report. When I am actually privileged enough to get an actual verbal report from the ED, it is usually from a thoughtful older experienced nurse who knows the importance of this handoff. Important info can be and has been missed without it, and accountability is lost also, e.g. STAT meds not given, antibiotics not scanned blood, urine, wound cx's not done before initiating antibiotics.) The ED nurse is usually gone by the time I have sorted things out and need to call about something.

We do not have any written report alternative as others spoke of, but the reasoning is because we can look it all up in EPIC. However I often need to call pharmacy to find out if a med was given or not (because it appears to be not given in EPIC (wasn't scanned in the ED) or lab to see if they received the blood cultures that were ordered to be held and so on.

Honestly, I don't like this new system of no report required!

[acerbia]

ER never calls to give report. Half the time transport doesn't call to let us know the pt is coming. I have never spoken to anyone from ER. I'm shocked this actually happens! I'm on med surg tele.