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

Nurses General Nursing

Published

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?

Although I can appreciate the challenges around ED nursing, the solution shouldn't exclude best practice(s) as its in the interest of both patient safety and best practice to give bedside handoff. This What the research says and hospital Management needs to do better.

I work at a Magnet hospital and we have toyed with different ways to get ED patients to the units in an hour total. We tried having ADT nurses bring the patients to the units and give a brief handoff to the unit nurse. This did not work because the unit nurse had pertinent questions that the ADT nurse did not know, so more often than not, we had to call the ED nurse who had the patient anyway. I would not accept a patient from the ED without report. I also use EPIC and often times I see labs still showing due from hours prior, testing that can be done prior to moving the patient upstairs (as opposed to making the patient move to the new room, get situated, then move again to go to CT, etc), out of control BPs without being addressed, stat consults not being called, and drips ordered that our unit does not take. As charge nurse, I look up each patient prior to my nurse getting report from the ED (We call the ED nurse to get it within 15 minutes of bed assignment). I have often questioned the appropriateness of assignments and this has led to less emergency transfers to higher levels of care. The ED is getting pressure to move the patient on their end, I know, and I hear that the patient is stable but upon reviewing the chart and talking to the MD myself, this hasn't been the case at times. Patient safety comes first! Bedside reporting is huge in my hospital and an absolute must when it comes to shift to shift report. The patient is included, and we verify IVs, wounds, drips/fluids, etc. together.

I would like to know which nurse would be held accountable if anything was to happen to the patient in a situation where the patient is dumped into a bed with nobody aware and something goes wrong. I don't think it should be the unaware nurse since that nurse hasn't even had a chance to accept the patient. I work per diem in a hospital that does fax report and all the info I need is never on there. I had a pt the other day who came in for AMS and nowhere on my report did it show he had fallen and hit his head or that he got sutures in ED. We don't get to see the ED notes. No CT was done for this pt either.

Specializes in Med-Surge; Forensic Nurse.

I think you're right. This is a lawsuit, safety mishap waiting to happen. The question I ask every nurse, where I work, and in my own reflections is this: Do we, as nurses, advocate for our own profession; and are we willing to take the risk of being ridiculed, mocked, and even terminated, because we are advocating for our patients, our profession, and ourselves?

I ask this because many of us have stories of unsafe working conditions, additional work requirements, and other concerns, but, I find that not too many of us are willing to band together and respectfully and professionally bring these concerns to management. I know there are numerous managers, supervisors, and administrators who will turn a deaf ear to our concerns, but, on the other hand, there are not many of us who will even take the first step to professionally consult, confront, and convene a conversation about these matters.

Remember, we, nurses, are at least one half of the problem if we continue to allow the problem to go on, unchallenged.

The hospital I work for still does verbal reports whether it's from ED to floor, floor to floor or if the patient is discharged to a facility.

In my OPINION, skipping verbal report and sending a newly admitted patient to the floor causes gaps in the quality of care we provide.

Verbal report provides the floor nurse with a brief summary (besides what's in the system) on what is going on with the patient.

This report should be short and straight to the point. If I'm the floor nurse, I need to hear SUBJECTIVE information about my patient. All the objective information is in front of me already on the computer.

If this report is taking longer than 5 minutes, the ED nurse and floor nurse need to re-evaluate their hand off techniques. If the floor nurse is taking longer than 10 minutes to return ED's call for report... There's another issue that needs looking into.

#1 priority in a hospital is patient safety and satisfaction, leave the nursing drama out of it!

Amen. SO well put. I said similar things to other nurses about how we could probably help improve the conditions we complain about if we stuck together. Everyone had reasons why they were scared/couldn't risk their jobs. I left the hospital/bedside because I couldn't take the stress on myself and seeing how unfair it is to our patients, how their care is compromised.

Specializes in Med/Surg, OR, Peds, Patient Education.
Although I can appreciate the challenges around ED nursing, the solution shouldn't exclude best practice(s) as its in the interest of both patient safety and best practice to give bedside handoff. This What the research says and hospital Management needs to do better.

In the "ideal" hospital setting, there would be ample staff and management would listen to those who know the situation/s. However, few hospitals, if any at all, are "ideal."

Dangerously low staffing in the ER/ED as well as in each and every unit, is the norm. Management's goal is the "bottom line," raising their own salaries and hiring additional management to write more rules.

Specializes in Critical Care.
As many here have attested to, it's not theory, it is happening. If the process is put in place correctly, patient movement from the ED can happen efficiently and safely without a verbal report.

My place does it for ED to floor transfers and has for quite sometime. It works very well. TJC and CMS have not disapproved of it, and I would bet my hard earned money that our hospital is among the safest there is.

The JC recommends a handoff process that includes "interactive communication", as does a number of other groups that look at patient errors and what can be done to reduce them.

The most glaring problem is that it can't both achieve the goal of excluded a verbal portion of report and not also be less safe. The argument for no verbal report is that floor nurses aren't always immediately available to receive report (they are sometimes in the middle of something else). The obvious concern is that this could mean the ED nurse is moving the patient to the floor before the receiving nurse has had an opportunity to get report (read the information and call the ED nurse with questions). The answer to that is usually that we can assume the receiving nurse has that opportunity (to get report and call the ED nurse), yet the basis for getting rid of a verbal report is that they don't have the time to do that in the set timeframe. So which is it?

Specializes in Med Surg.

Agreed. Short and sweet, just the pertinent info is best. The rest we can look up. The RN may remember to tell me something about the patient in report that he/she forgot to chart. Many times standing in front of the patient for report can prompt the RN to remember this important information.

The argument for no verbal report is that floor nurses aren't always immediately available to receive report (they are sometimes in the middle of something else). The obvious concern is that this could mean the ED nurse is moving the patient to the floor before the receiving nurse has had an opportunity to get report (read the information and call the ED nurse with questions). The answer to that is usually that we can assume the receiving nurse has that opportunity (to get report and call the ED nurse), yet the basis for getting rid of a verbal report is that they don't have the time to do that in the set timeframe. So which is it?

For a verbal report, both nurses have to be available at the same time.

Where the "no verbal" report process is in place correctly, the receiving nurse gets advance notice. In my case, the floor get at minimum 30 minutes. It's usually more like 45-60 minutes. They just have to carve out 5-10 minutes or so to review the chart without having to get in touch with the ED. The charge nurse also usually reviews the chart to make sure the patient is appropriate for the floor.

And, if the receiving nurse happens to be unavailable at the very moment the patient arrives, why is it such a big deal for another nurse, a tech, charge nurse, etc. to lay eyeballs on them and make sure the patient is ok?

The patient of coorifice should be stable enough to survive the recieving nurse not being immediately available. If not, that is a seperate issue, which BTW having verbal report would fix.

People are welcome to disagree. But I can't buy the argument that it isn't safe as I have lived it (as have others who have spoken here) myself in two different facilities, and my current one I would put up there with the best as far as patient safety goes.

Specializes in Critical Care.
For a verbal report, both nurses have to be available at the same time.

Where the "no verbal" report process is in place correctly, the receiving nurse gets advance notice. In my case, the floor get at minimum 30 minutes. It's usually more like 45-60 minutes. They just have to carve out 5-10 minutes or so to review the chart without having to get in touch with the ED. The charge nurse also usually reviews the chart to make sure the patient is appropriate for the floor.

And, if the receiving nurse happens to be unavailable at the very moment the patient arrives, why is it such a big deal for another nurse, a tech, charge nurse, etc. to lay eyeballs on them and make sure the patient is ok?

The patient of coorifice should be stable enough to survive the recieving nurse not being immediately available. If not, that is a seperate issue, which BTW having verbal report would fix.

People are welcome to disagree. But I can't buy the argument that it isn't safe as I have lived it (as have others who have spoken here) myself in two different facilities, and my current one I would put up there with the best as far as patient safety goes.

The argument for how the receiving nurse still has the opportunity to ask questions is that they can call the ED nurse, so by definition both nurses still have to be available at the same time to talk on the phone even without a verbal report. If the purpose of not including a verbal component is to move patients regardless of whether or not there was an opportunity for the two nurses to talk then it can't be both successful in it's purpose and safe at the same time.

If our only goal in taking care of patients is to make sure they don't die in the few minutes surrounding a transfer then it's true, that risk is more easily mitigated, but that's hardly our only purpose.

Specializes in Med-Tele; ED; ICU.
A situation happened recently where a transfer, after 10 minutes going to the bathroom, was found cyanotic with no pulse. It was not reported he had a history of mitral incompetence.
Pretty sure it was in the EMR, though... either way, would it have made any difference?
+ Add a Comment