It used to annoy me as a new ED nurse (And I transitioned from Med-Surg to the ED!!!)
Now it doesn't bother me as much. I say "Sorry, I don't know" and leave it at that.
I do get annoyed when a NURSE or Radiology Tech etc. would call me (about an ADMITTED patient on the floor!) and ask "Why wasn't XYZ labs ordered" or "this test was ordered wrong and needs to be ordered as..." - How about you call the ruttin' ATTENDING (or the provider) who wrote that GORRAM order??!!
Speaking of transitioning, when I worked nights and used to take verbal admission orders - I'd try to make sure the floor had: something for pain, something for nausea, something for constipation, something for insomnia and something for a fever - to get them through the night. I'd also try and advocate ("Yeah, 2 mg Morphine q 3 hrs isn't gonna cut it Doc. Wanna do 4 mg q 3 PRN?" Or "You ordered percocet. Can I get an order for some Zofran just in case?" etc.)
When I worked Med-Surg and got admissions, I'd usually want to know:
* Pertinent PMH. If they're being admitted for Sob, DO tell me about cardiovascular disease and diabetes etc. Don't really care if they had hemorrhoids or not (i can get that bit when I have to do my admission stuff anyway).
* Change in status. Meaning? What did they look like when you first got them. What do they look like now. Better? Worse? More confused? What is baseline by history and what was baseline in the ED?
* Any abnormal findings on assessment/radiology/labs. I'm going to review the chart and do a head-to-toe when pt. gets us here anyway. A heads up on what to watch for is always nice.
* Treatments/meds administered. Allergies.
That was pretty much it.
I will admit that I used to think that the ED used to hold their patients until shift change too - until I started working in the ED. What I didn't realise was that on the floor, if you had a 4 patient assignment (for example) and you hit 4 patients, you were done. In the ED, you'd get a 5th or even a 6th patient in the hallway. And in some places I've worked, if you had a room assigned and admission orders in - if you were taking too long to call report and dispo the patient (goal was to have pt. dispo within 60 minutes of bed assignment) your charge nurse or assistant managers would call report and get the patient up!
I'm glad you mentioned that. Because to me, your post is the essence of "When will everyone understand things are different in the ER", in my honest opinion.
Well, no. A patient isn't admitted (since you mentioned reimbursement later on in your post) while in the ED.
It matters so much with hospital reimbursement that nobody from risk management, QI, or administration has come down and talked to us sloppy ED nurses (in any of the EDs I've worked in over the years) about our negligent skin assessment documentation.
Y'know, the same folks who are probably aware that I routinely take care of acute strokes, coding babies, MIs, abusive drunks and drug seekers, traumas and vented pts. on multiple drips etc... but won't let me sign up on the schedule to work if my yearly Glucometer competency and testing is not complete??!!