Verbal Hand-off Reports - Are they no longer necessary?

[yr.pedsnurse]

I work as an acute care Med-Surg float nurse and my hospital has implemented a new process where patients are being transferred to units from other units, ie. the ED to the floor, ICU to the floor, and from affiliate hospitals to our hospital without having to call and give a verbal report. I find this practice outrageous and an accident waiting to happen.

The reason behind this new policy is to expedite patient transfers and open beds faster. All I ever learned is how important patient the hand-off is, and now we are actually no longer required to give report to the next nurse who will be taking care of the patient.

Apparently now that we have the EPIC system to do our patient charting, the decision-making people feel that verbal reports are no longer needed. However, I have had several instances where EPIC contained very little patient information and virtually no history, so I literally had to ask the female patient, who was busy vomiting, why she was even admitted to the hospital. The fact that she was a stage 4 CKD patient with only one remaining kidney was nowhere to be found on EPIC. She needed pain meds, but her current medication reconciliation had not been completed, delaying her receiving any medications.

And I must also stress the last Magnet hospital I worked at did the same thing by getting rid of verbal report for patient transfers. Has anyone else been experiencing this practice, and if so, how do you deal with the huge safety risk? What happened to placing patient safety first?

[amzyRN]

I don't find this problematic necessarily; though I think if there are questions there should be someone available to call for clarification. What more needs to be explained on a new admission besides diagnosis/reason for admission, history, labs/tests and pending procedures, IV access, skin issues, mobility, orientation, isolation precautions? You'll find out everything else you need to know once the patient gets to the floor.

I like my report short and sweet, just the pertinent info.

[VANurse2010]

I've left a job largely because of this nonsense, and won't work somewhere that does it. Fortunately, it's anathema where I am now not to call and give report.

[yr.pedsnurse]

I agree with most of what you said, except that in some cases, as I mentioned, the computer has very little information, including basic information such why the patient is admitted and pertinent past medical history. And yes, we may find other information once the patient gets to the floor, but until someone arrives, such as the admitting resident we know very little unless we ask the patient. And what if the patient is menatlly incapable of giving that information? In a perfect world with complete documentation, maybe verbal report is not needed, however, I am finding more and more that is not the case.

However, I thank you for for your response.

[yr.pedsnurse]

Maybe I need to find a place with the same standard. Thanks for the comment.

[amzyRN]

I've never received a patient that didn't have notes by MDs explaining why the patient was admitted. Even a brief ED note often gives me enough info. It's often the floor nurse that obtains the med rec, since ED is usually busy. Usually pain meds are included in admitting orders, even if home meds have not been obtained, at least where I work.

I think you should bring this up to your manager or something, basic info for safe patient hand off should be contained in any report, written or verbal. I don't think a verbal report is necessarily better though, it can be meandering and still not contain essentials.

[guest64485]

Ugh, that's awful! Reports are very important to highlight critical areas of information/concern, including social issues that aren't appropriate to be written in the chart. Is there any way they can do a taped report at the very least?

[emtb2rn, BSN, RN, EMT-B]

Ugh, that's awful! Reports are very important to highlight critical areas of information/concern, including social issues that aren't appropriate to be written in the chart. Is there any way they can do a taped report at the very least?

"This is emtb2rn. The pt is a 53 y/o male, history of htn & cholesterol. Intermittent sternal chest pain x3 days. No pain the er, rsr, got 324 of aspirin, trop negative, 20 gauge in one of his arms, serial trops and stress test in the am, transport without tele." How do i in the ed leave that taped for the floor? We put it on the faxed sbar.

[MunoRN, RN]

In my state that would be considered patient abandonment by the BON, handoffs must include a verbal component. It's also a Joint Commission requirement.

If it's really true that nothing is lost by just looking the computer, why apply this standard (or lack of standard) to just ED to inpatient unit transfers, why not just get rid of shift-to-shift reports as well?

[MunoRN, RN]

"This is emtb2rn. The pt is a 53 y/o male, history of htn & cholesterol. Intermittent sternal chest pain x3 days. No pain the er, rsr, got 324 of aspirin, trop negative, 20 gauge in one of his arms, serial trops and stress test in the am, transport without tele." How do i in the ed leave that taped for the floor? We put it on the faxed sbar.

How does the receiving nurse ask a question of a faxed piece of paper?

[ED Nurse, RN]

We also no longer give report to the floors- there was too much arguing, stalling on taking the pt, causing backlog in our end. The pts admitted to the floors are stable- we out an sbar in the progress note and leave our ascom direct number if there are questions. ICU pts we call and speak with the nurse- but most ICU nurses I work with read through the chart so they know the PERTINENT info to ask. Works very well. No harm, in the several years has this been going on, has the situation been unsafe or causes harm to a pt.

[nutella, MSN, RN]

I worked at a hospital that went from verbal report to electronic report from the ER because nurses would not pick up the phone or take report - hence pat throughput was not going well. The unit coordinator gets a note saying the patient comes to the floor and the nurse has something like 45 minutes or so to read the electronic ER report. The patient hits the floor no matter what - also change of shift...

I worked in acute dialysis and one busy hospital used an SBAR form for all patients going from acute dialysis back to the floor - I filled it out and no verbal report was necessary unless something unusual happened. It is just such a busy place that nobody has time to pick up the phone all the time for reports. In a different hospital they require verbal report and it is rough to get pat out of dialysis because nurses won't take report saying it is not convenient ....