Transporting Patients from ER to Floor. Your Process?

[melmacrn]

My hospital's current ER to floor admissions process involves the emergency department nurse taking the patient to their assigned room in PCU, ICU, medical-surgical or where ever the patient is admitted. This takes an emergency department off the floor in an already short staffed and busy ED. We have researched other facilities and are finding that other hospitals have individuals who come to the ED and take patients to their assigned room once a room has been assigned.

Does your hospital have staff members who take admitted patients from the emergency department to their assigned rooms/departments? Is there a specific name for this process? Also if you have any research articles you would like to share regarding this (especially ones concerning patient safety).

We are trying to collect research and sharing your experiences would be greatly appreciated.

[CX_EDRN]

Our techs do most of the transporting to the floors, unless they are monitored. Our ICU RNs come get their patients and the obs floor usually sends a tech to come get their patients from us. We have 30 minutes from bed assignment to get patients out of the ED and the floors know this and work pretty well with us.

[kalycat, BSN, RN]

We have transporters to manage all non-monitored, non dangerous patients as others have mentioned.

However, we also have float pool RNs on pager to assist with transport of monitored patients that require an RN at all times. They also assist with the admission process. The assigned RN and charge (we didn't have CNAs) greet the patient when they arrive, get them settled, do an initial assessment. The float nurse asks the admission specific questions. (Note, this is night shift on a specialized cardiac stepdown unit that also took icu overflow within certain parameters). The helper nurses for different floors helped fulfill this role during the daytime.

RNs never left the ED. Floor nurses would transport VADs and transplants for procedures, etc and go get said patient's from the ED; at my facility you have to have a cert to take a VAD or fresh heart transplant anywhere. Transporters would come to help manage equipment. Having a VAD crump in an elevator is bad juju. Usually if they were very unstable we would transport with the rapid response/cvicu VAD team and anesthesia.

I felt this this process worked fairly well - we had a free charge who helped facilitate all this, and the float pool RN was an invaluable resource. I'm in ICU now and our admits arrive with a full team, usually, because we are a closed and specialized high acuity unit. But the ED nurses never have to leave to my knowledge. Hope that helps a little!!

[ChadlyRN]

If the patient is going to the floor our transporter (non-clinical) takes them. If they're going to the floor with a drip like cardizem the nurse must transport. Also, if the patient has to go to a critical care bed the nurse transports with a portable monitor.

[manager123]

Just curious as this is a hot topic here as well. Why is it ok for the floor to leave to go to ED for transport (and probably leave the floor out of ratio) if the ED is concerned about out of ratio as well?

Obviously the ideal state is to have a resource RN of some type stationed somewhere to pick up or deliver but floor staff question why ED is upset about transporting 'when no one seems to understand the same thing is happening on the inpatient unit and no one cares about them or their patients'?

Part of the issue is probably the lack of ED support in times past when they had a quiet night and the floors couldn't even get them to come up and help with a difficult IV yet the floor staff are expected to float wherever and whenever. I fully understand ED dynamics of 'anything could happen at any minute', but there are times when help and support would have been greatly appreciated. Floor nurses have seen those "snapshots in time" moments when all of the ED staff are 'just sitting' and the floor came to get the patient and left a chaotic unit to do so.

How are you addressing what seems like a disparity of collaboration? Or perhaps your areas are more collaborative than what I see?

[Bobjohnny]

Just curious as this is a hot topic here as well. Why is it ok for the floor to leave to go to ED for transport (and probably leave the floor out of ratio) if the ED is concerned about out of ratio as well?

The way that it helped level load this a facility I previously worked at was that during the 'Golden Hour' ED was required to transport all patients. From 0600-0800 & 1800-2000 all admits were required to be transported by the ED RN. The rest of the time the inpatient nurse was required to come get the patient. Our bed management was also able to see the ED tracker and was able to determine if we were dead, if so ED was asked to transport the patient.

My current facility uses a different method. We recently got dedicated ED transporters. They take patients to radiology as well as transport them to the inpatient units. Transport cannot take monitored patients. However, they are only available 1100-2300. The rest of the time our EMTs transport patients(this can include monitored patients). The only ones RNs are required to transport are patients going to ICU & some medication specific things (ex: nitro, cardizem, cardene, dopamine, dobutamine not going to ICU).

[EDRNCCmom, MSN, RN]

Just curious as this is a hot topic here as well. Why is it ok for the floor to leave to go to ED for transport (and probably leave the floor out of ratio) if the ED is concerned about out of ratio as well?

My only comment to this is from an ED perspective. One busy Sunday, I walked my vented respiratory failure patient to the units. My other three patients were caught up when I left for the units. When I arrived in the units, they had three RNs and one tech waiting in the room. When I returned to the ED, I had an ambulance crew in the room I just left and orders on two other patients. The only one thing I can see different between the ED versus floor transporting patients is that if there is an empty bed in the ED it gets filled if nothing else is available. If no float nurse is around, the ambulance crew simply waits for the nurse to return. To my understanding when another nurse leaves the unit, they do not return to have a new patient that they had no knowledge of. This is simply the nature of the ED beast and we accept it who work at it.

I agree that an assigned nurse/resource nurse would be perfect for this role of transporting patients - this would allow the ED nurse to stay in the ED and the floor nurse to stay on the on the floor. This is definitely a question with no easy answers.

[GCom24, ASN, RN]

We have recently changed our report and transport processes. ER Techs can transport all pts except ICU. If the pt is going medical, then our report is filling out a SBAR form, faxing it to the floor, confirming that it was received, do you have any questions, okay the pt will be up in about 15 minutes. Done. We must give verbal report for ICU and step down pts. It works pretty well other than certain med-surg nurses insisting on a verbal report.

[RainMom]

Can't imagine not having a dedicated transport team during peak hrs. They take new admits to the floor, discharged pts to their vehicle, surgical pts to & from the OR unit, pts to radiology...and this is a small 100 bed rural hospital.

After hrs, ER nurse or tech takes new admits to the floor, but sometimes ask the floor to come get them if they are slammed. Sometimes the supervisor will transport an ER pt to the floor if everybody is tied up.

[Shanua]

ER Techs transport generally. ER nurses do frequently though. There are 16 beds in the ER and only 2 nurses after 11pm (2 on days, a 10a-10p, and a 11a-11p). A tech is scheduled every night. Sometimes if they are busy or it'll be a bit they ask the floor nurse or charge nurse to come get the patient. I have never turned them down. It's a team situation. Most of the ER nurses are great and more then willing to work with the floor nurses and vice versa.

[brillohead, ADN, RN]

I work nights on a cardio-pulmonary telemetry unit that also does "intermediate care" (critical drips, continuous bipap, etc.) and chest pain patients.

Patients that are on a monitor have to come up with a telemetry-trained employee, either a trained ER tech or an RN if none of the available ER techs are tele-trained.

Patients that are on a critical drip (cardizem, heparin), Venturi mask, BiPAP, or have a chest tube have to be accompanied by an RN.

Occasionally there will be a "resource nurse" working that can handle transports -- this is often an ICU or cardio-pulmonary nurse whose unit has a low enough census that they don't qualify for the extra body, but they don't want to call them off entirely because census is anticipated to rise over the course of the shift based on what the ER board is looking like that night. The nurse floats to the ER just to help out with whatever is needed (vitals, transporting, monitoring a patient in hard restraints, etc.) until such time as they get recalled by their own unit (usually within 4-5 hours).

[supakimchee]

Any monitored pt. gets a nurse for transport (ICU, PCU/SDU), ward transfers are handled by our NAs. We do not have a transport team or transport RN (I wish LOL). However, we have a huge shortage of NAs because they also have to sit as well as run blood, take bodies to the morgue, so nurses also commonly have to transport our ward pts.

We used to have unit support assistants, but we don't anymore as well. Oh, we also have zero ER techs. I know what I'm asking Santa for this Christmas.