Change of shift admissions

The problem from the ER point of view, is that shift change can block a transfer for as much as 2 hours. But the ambulances keep coming, the front door is constantly revolving, and I have people in the waiting room for as much as 4-6 hours. I need that ER bed. Most days when the charge is making assignments (we meet as a group, then go get indiviual report), part of the briefing is how many admits are waiting for orders or beds. Usually between 10 and 19. Takes up a lot of ER beds, not just the one I'd like to send to you.

I have floor nurses resist report because it "almost shift change" "they are in report" (someone is watching the floor aren't they? it is just the verbal report you are passing on, and don't you want to know what is coming while making assignments?), or "we just got out of report, I have to assess the pts I already have". Yep, up to 2 hours of delay.

Before I get flamed, I worked the floors for more than 15 years, I know it from both sides. Why do we wait until shift change? ah, we don't. That is when the bed was assigned, and if I have a delay, its because something else is going on that took priority (we are an emergency room).

Had a nurse not want report, due to shift change, then demand I do things off the admit orders, because they were written at 1730, so I had over an hour to have done those routine things. Again, no, routine things are only done in the ER if there is a delay of many hours. Thing is, I had just come on, the previous nurse was still trying to keep her ICU pt alive and transferred, and I was helping out by doing the admit. But the floor nurse wanted to write me up about it (I spelled my name for her). Come on guys, we all care about the patients, and we all need to work together.

So, if your no fly zone is actually only the half hour between 19 and 1930, yeah I can work with that. But that isn't the way it works out in reality, which is why our hospital went to no refusals. I have 45 minutes from the time the room is posted to send the written report to you, let you check it, verify with a quick phone call, and get the pt transported. Or get called in to explain why I am so slow on the admits. They track put through times in the computer.

We are a 40 bed level 3 trauma center.

One of the hospitals I did clinicals at had a policy where no patients could be transferred to the floor between 630 and 8. We were informed that this policy was instituted after a patient DIED. The patient was brought to the floor at 645pm from the ER. On the floor the day nurse was giving report to the night nurse, and the night nurse was getting report. The er nurse called to give report to the floor was put on hold for a long time, she hung up and called back and the secretary took a callback number to give to the oncoming nurse. The patient was already in the room and should not have been sent yet. The patient got overlooked in the shuffle, and it was some kind of cardiac death but it was not a cardiac floor. I am not certain all of the details, but this is what we were told during our clinical rotation. So basically what happened was, a group of admits at 625, and then a group at 805.