Tele transports from the ER

RNKPCE · Feb 3, 2004

If they have to be monitor continously then an ACLS trained nurse will transport. If they are a stable r/o MI with no arrhythmmias, or any other stable cardiac patient then come up with a transporter. The doctor orders the way and/or the ER nurse uses his/her discretion. Same goes for staff nurses with tele patients leaving floor for tests.

Calfax · Feb 4, 2004

I'm a military RN, for our tele patients, the official protocol is that an ACLS trained nurse and corpsman with a monitor and a jumpbag must transport patients to and from the ward or to x-ray or ultrasound and must stay with the patient.

However, this is not always possible....or always necessary. I'll usually transport the patient to a tele ward just on a monitor and O2.......usually by myself. But it's a judgement call.

Now if it's an ICU patient, especially a real one, that's different. You take what resources you need. But staffing is unfortunately very limited at my facilty. I'll use family members, sometimes, if I need help and there's no one available for transport.

erjulie · Feb 8, 2004

QUOTE]Originally posted by EMT-JEEP

In my ED, Nurses refuse to push a bed. I work as a medic and I tend to do all of the transports. To RAD, MICU, SICU, PICU, CCU, Angio, Cath Lab. Any medic, or EMT that has sat through a 4 hour TELE course and can push a stretcher does it all. I usually end up giving report to the MICU, ICU, PICU, and/or Cath lab on the patient because the nurse didn't bother to call and say the pt was comming up. I personally believe that somebody actively infarcting, going to the cath lab, on NTG and Heparin gtts should be monitored by RN especially since while in the hospital I am not allowed to change doses/ DC. I Have been stuck with respiratory in an elevator when my pt's propofol pump stopped. I was repremanded for re-starting at same rate even though the pt would have ripped out his ET tube if I hadn't :confused:

That STINKS! Your rns treat you bad. and they are treating their patients worse! You should never be in a situation with an unstable or "dripped" patient...at our ER, nurses make the call, if they are any way unstable, an RN and tech/paramedic transport. I try to help techs transport to general medicine floors, too, because after years of being the tech, then nurse, and transporting by myself, the hips, shoulders and spine are going, and I'm only 52!

Medic946RN · Feb 9, 2004

Originally posted by Speculating
It all sounds good with the monitors and ACLS...But then who takes them (tele) to radiology etc.

I always chuckle when the Doc okays pt to go off monitor to tests, but has be fully packaged with 02, monitor, running IV line to go to PCU even their admitting hasn't ordered half that stuff. The level of care the Doctor prescribes should be the standard, not the destination of the pt. In my ED we have a few ED techs that transport to PCU, RN's must accompany pt to ICU, anyone can take someone to Med/Surg, even transportation.

sun_chica · Feb 18, 2004

I'm a unit clerk in an ER, for pt's going to ICU/PCU the RN (ACLS cert) & a security aide, clerk, or patient care assistant goes w/. Patients are monitored while in route to unit.

RNin92 · Feb 19, 2004

this is a sore subject in our ER. Tele patients must be transported from the ER to the unit of choice (either ICU, CCU or PCU) by an ACLS RN.
BUT if it is a patient being transported from CCU/ICU to our Progressive Care Unit (tele unit) then they can be transported by our transporters, without an RN. go figure.. makes no sense.

This is interesting. I was thinking about our ER and how we transport.

We have no policy...although I often here people to refer to one...it does NOT exist at our hospital. The "rule of thumb" is the RN decides. If it is a med/surg pt. anyone can transport. If it is tele and the RN thinks they are stable they can transport with a tech. (Most of our techs are EMTs or Paramedics...MOST) ICU always transport with a nurse. And anyone going to a monitored unit (tele or ICU) needs a monitor during transport.

Our hospital is like yours veetach...the patients on the floors transport by ANYONE. 10 minutes after I take up a tele pt. the floor can send them with an 80 y/o volunteer in a w/c without a monitor!!!

We used to throw them on a portable monitor and up we went. I thought...so I can see your V-Fib...so what!!! What good was the monitor without the defibrillator?!! And if they go into an arrythmia that I can treat...I have no meds!!! So what exactly is the point anyway?

Now we take an AED with us. But unless I am stuck in elevator for a LONG time...by the time I slap on the AED and administer the shocks, I pretty sure I will be at the unit-with MANY people around!

I think that a critical patient needs to transport with an ACLS-RN and someone else to assist. I think a critical patient needs to transport with a life pak 12 (or similar) attached so you can monitor AND deliver a shock if you have to en route.

Everyone else should be discretionary at the judgement of the nurse taking care of the patient. Just like everywhere else in the hospital. Unstable is unstable...no one needs to have a policy thrown in their face to tell them which pt that is. The flipside is EVERY tele pt is not unstable. At all.

Our hospital is very into finger pointing I am afraid and if there is any questionable situations...the first question is...who transported the pt? Was it a nurse? Funny no one has ever asked...does that transport person have ACLS? Would the outcome had changed if the tranporter was an ACLS-RN?

Sorry...didn't mean to go on a rant...had a bad situation last noc and I guess it is still fresh in the brain!!

casper1 · Feb 19, 2004

A Nurse and a tech with a monitor is the recommended protocal. If the patient is stable enough and the ER is busy with limited resources a MD will suspend the tele order for transport with the understanding it will be started again upon patients arrival to room.

rjbaileyrn · Feb 19, 2004

Who can transport a pt to a tele floor in your ER? We are using anyone who can push a cart, RN, PCA, Secretary and even volunteers, some who are high school students. Just wondering about the liability and what other ER's are doing about transport. If the RN is in charge of transporting the patient, they would be transporting all day, and be off the floor too much.

RN's Only at the hospitals I've worked.

teeituptom, BSN, RN · Feb 28, 2004

If the pt goes from a monitor to a monitor, pt needs to be monitored and accompanied by an RN

simple rule

TinyNurse, RN · May 20, 2004

in my ER the patient must be on a portable monitor with an ACLS trained RN or Medic.

KRN · Jan 11, 2005

In my department, if patient is on a monitor, a paramedic or RN may transport the patient to the floor. The RN caring for the patient must accompany patient to ICU or CCU. We had EMT's who took ACLS so they could help but the hospital said NO WAY and wouldn't reimburse them. We now have a small drug box too and must tak a BVM with us. We transport with Zoll's or Lifepaks so d-fib is not a problem. My problem is who's going to manage the airway while I do CPR and push drugs on the way to the floor??? :rotfl:

TinyNurse, RN · Jan 18, 2005

If the patient is on tele on the floor , we use either an ACLS RN, or a paramedic. ( would anything else be responsible?) xo Jen