report between pacu and ambulatory care nurses

[toria06]

I work in the ambulatory care (same day surgery) setting and recently the staff where I work and in PACU are unhappy with the level of communication and proceedings of the handoff of patients. As of now, the PACU nurse transports the patient to us and gives a verbal report at the bedside. The PACU nurses are unhappy with the process and would like us to retrieve the patients from them. It seems that if we have to retrieve all the patients from them, that there may be a delay in the process as we only have 2 nurses who receive all the post ops and discharge them. None of our patients go from PACU to the floors, they all come back to us. I was wondering what the process is like in other facitilies, hoping someone can give us a better plan of action....such as who transports the patient between units and how report is given, ie via phone or at bedside? any suggestions would be helpful.

[HouTx, BSN, MSN, EdD]

In my experience (with multiple settings & systems), it is far more likely to have a process that allows PACU nurses to stay in place rather than transport because they have to maintain a set pt:nurse ratio at all times. Larger organizations have dedicated transport staff (including an RN) who take the patient to their post-op destination. Smaller organizations expect the receiving dept to fetch the patient.

An ideal arrangement would be based on logistics and standards rather than a hard and fast rule. For instance, if it is a 'last case of the day' situation and the PACU nurse can transport without jeopardizing the patient ratio... and the receiving department is being slammed - it the PACU nurse should transport.

The best inter-departmental transitions are based on some sort of absolute standard - normally involving a checklist so that nothing is missed. So, the 'sender' can give the 'receiver' a verbal report, but the process should also involve a detailed written record of essential information. That way, the verbal can be focused on the 'extra' stuff that should be communicated but not necessarily documented... you know the stuff ... "he's got a crazy family with 3 xWives and a girlfriend out there so you're gonna have to be ready for drama and crowd control" or "his cousin said the patient's girlfriend is planning on sneaking some grass in during visiting hours this evening" -- hey, we've all been there, right?

[somenurse]

Our outpatient PACU and our "phase 3" (discharge room) were side by side. No hallway at all, the 2 rooms were actually attached, we could, if we wanted to, see into the room next to us, if door was open. Moving patients from one room to the other, took only minutes.

Typically, PACU brought the pt to the phase 3 room,

but, we had great teamwork there, and if PACU was swamped, or dealing with pt not doing well, the phase 3 nurses came to collect our outgoing pt.

but

We phoned report from PACU, so that way, we were not out of the PACU room that long. When we got to 'phase 3' room, we'd update if anything at all had changed from the report we gave 5 minutes ago.

During phonecall, we'd usually ask something like, "Is it okay if i bring pt over in 5 minutes then?", giving phase 3 nurse time to prepare, and every once in a blue moon, not often at all, but every once in a while, the phase 3 nurse would ask, can you wait and bring pt cuz we are taking a pt outside right now, or whatever.

but, this didn't happen often, as each dept had monthly measurements of how long a pt stayed in each dept, and that was huge deal to management. Any extra minutes, and PACU could have pt going over the standard minutes. (of course, various pts did go over, for various problems they had, but, overall, we had to keep eye on clock to please management).

or sometimes, PACU rn would ask, "Any way you can come fetch this one, as we just got some patients with ET still in, can't leave" or whatever.

but usually our pacu nurse brought the pt to phase 3. But, PACU just ONLY roll bed in, or W/C in, and did not stay to assist pt into chair, so it was a quickie thing. We did examine dressing or op area together, prior to PACU rn leaving. Phase 3 nurse always scurried over to take pt the moment we entered phase 3 room, took us to whatever curtained area was for that pt, we looked at surgery site together,

and we returned to our PACU.

maybe this only worked for us, cuz our areas were side by side. In a hospital PACU that i worked in, the phase 3 nurses came in PACU to get patient, cuz it was a bit of a walk to get to their dept. Still, we phoned the reports, to shorten the time the nurses were out of their depts.

[meandragonbrett]

Our report is written. We have a sheet with options to circle and fill in the blank. We tube report and the receiving unit (inpatient or outpatient) has 15 minutes to call and ask any questions. 15 minutes after report is tubed the patient is added to the OR Transport list and is taken to wherever they need to go by the OR Transport staff. PACU RNs never transport/leave PACU unless it's a monitored pt.