Transfering patients

A strict timeline is rarely the answer when busy staff is the problem. The whole thing sounds stupid, to me.

How to make patient transfers appease everyone involved has always been the holy grail of hospital problem solving, although it's not really all the complicated, we just manage to go out of our way to make complicated.

It sounds as though the biggest barrier is getting two rehab staff freed up to come and get the patient being transferred. I get utopian goal of having the rehab staff meet the patient before they've even left for the rehab unit, but you also have to consider what the consequences of this will be, which your upper management doesn't seem to be considering. If the patient can't transfer in a timely manner, it means they are left with lets say, a GI bleeder in the bed next to them, continuously blasting GI bleed feces into a commode three feet from the patient waiting to transfer. What I would ask the upper management proposing this system is if they are familiar with what GI bleed smells like in closed quarters, most likely they will say "no", in which case I would ask why they feel they should be able to have any input at all into the matter.

Does your hospital have a transport service? We use them for transport of any patient who does not need monitoring or have any drips or PCA, usually discharges or transfers to a less acute department.

Transfers and discharges often end up being late in the day because the doctors don't get around to writing the necessary detailed discharge transfer/discharge orders until they are less busy as well, well after rounds and critical matters are dealt with. Is that a roadblock?

The job I just left had similar issues but it was because our transport team was not getting to the ER in a timely manner to transport them up to us. The solution was the nurse getting the patient will go get them and the nurses will transfer patients between floors. We also had 30 minutes from the time the ER called to say they were till we were back on the floor with the patient.

We had 5-6 patients each shift, it is very hard to get away to go get a patient and bring them back within 30 minutes. Most of the nurses on my floor were so sick of doing other employees jobs because they didn't have enough transport staff, that we just ignored the 30 minute limit. Admissions are part of nursing, I don't care to get one. But I'm not going to rush the care of the patients I do currently have to help the hospital figure out something simple as transport.

Once I had all my patients good to be left for a bit, I would go get my patient. Sometimes it was 15 minutes, sometimes it was over an hour. I figure if they need them out of the ER/another unit that bad, one of the salaried folks sitting in their office can bring them...

I'm looking for two things here, opinions and advice.

At the hospital I work they follow the same model as Toyota in regards to organization, efficiency, and cost effectiveness.

I'm going to tell you a couple of things in hopes of sparing you some future agony - because you sound like someone who cares about nursing things/taking good care of patients/doing a good job.

The very best thing you can do is realize what exactly the overall program/agenda is. These are business agendas and interventions. Some of them are better for patients and for business, and some of them are just better for business. The particular change your unit is trying to make is probably one of the former. Patients should be promptly moved to the appropriate care area for patient reasons and for business reasons.

When they have a problem area they put together a group of people and they come up with a solution. The solution is tested and data is collected and reported out every month for 3 months. We're in month 3.

How this goes: They have something they want to change. That is number one. They are not working on things nurses want to change. They put a group of people together who can get on board with the changes. Voila - those people just happen to come up with the very procedure that was always in the works from the get-go.

Our unit did one on the admission process (for hospital subacute rehab). The problem was patients were being transferred very late in the day. This was in part because our nurses were always waiting for a time that they were busy (which is rare) and the sending unit would hang onto the pt to avoid an admission of their own.

The solutions were

*A goal time to get report within 30 min of being told they had an incoming admit

*A planned time for the patient to transfer

*Two staff members would leave our unit and go to the pt to bring them to our unit

The first two solutions were very effective in getting the patient admitted sooner. The last one has been very challenging.

Some roadblocks are -

*When one staff member is ready, the other is not

*The pt is not ready when we arrive

*The pt has needs when we arrive (toileting or clean up is the big one)

*Who is responsible for the care of the pt has come into question.

*Liability if an injury were to occur in our hands while still technically admitted to their unit.

I have brought these concerns to management and so have others but the consensus is upper management believes it is good for the patient and good customer service to greet them before they come to our unit and escort them.

What do you think about this process and how might I again bring this to their attention so that they can understand how inefficient it is.

Today it took about 40 minutes. 1 RN and 1 CNA were off the floor at this time basically waiting and being nonproductive. This isn't the norm. Usually the patient is ready and it's a 5 minute thing. But when it's not quick, it is very frustrating for the staff.

A couple of things:

1. Their first priority right now is to effect change; to institute something they see as a patient satisifaction intervention. Any of the concerns you listed above will not be taken kindly at this particular juncture because no negative feedback is desired or allowed. This is the Culture of Change.

2. You should not bring this to their attention again, IMO. Either their "data" will eventually show that it's problematic and then they will want to amend in the name of efficiency, or else it won't - and everyone will just have to get used to it. Hopefully times are being logged already. Whenever it takes longer than it should, you should note why ("pt found soiled and required personal care x 15 minutes"). *EVERYONE* must participate in logging stuff like this. What tends to happen is that people are frustrated at the way the LEAN/Toyota Production Line crap was instituted and they are already busy, too, and logging everything just makes the task itself take that much longer. So people don't log it and then the architects of all this have nothing to report except how excellently everything is going. They know, too, that people will "gripe" about problems, but not record them. This works to their advantage because if only 2 or 3 people ever log anything, it's easy to single them out. "Everyone else loves it...."

3. Get used to this, and have a good attitude. I recommend a lobotomy. Or at least a separation of "self" from "this." None of this is a hill to die on, so-to-speak. Don't make the mistake of becoming too passionate about things like the concerns you mention above.

4. Work hard and save up your credibility for things that really matter, like legitimate and serious safety issues. This Culture of Change mentality inevitably produces those kinds of problems, too, and you'll have a much better time being heard when it counts if you don't get all up in arms about minor things.

5. Try to see the good in some of the changes that will be coming your way. Look for the positives whenever possible.

6. Take the best care of patients that you can, every day, within the limits you are given.

Lastly - Why, actually, does it always take two people to go and retrieve a patient? Unless there are special circumstances (lots of equipment, etc) I can't think of a good reason why this is necessary. How did that come to be/what was the thought process?