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

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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?

Something like a patient coding and you know nothing about them, not even if they are a DNR/DNI because you barely knew they were coming, let alone have time to look them up on the system. Electronic reports give only a small picture about what is going on. A verbal report can fill in the necessary gaps. I worked at a place where they faxed an SBAR report. These had similar drawbacks.

If you don't know anything about them, that is a different issue then verbal report vs chart review. You could receive a patient without getting a verbal report too, thus you wouldn't know they were coming in that instance either.

I can look in a chart and find what I need to know faster then hooking up with the other RN for a verbal report.

What "gaps" do you need filled in? Why they are here, vitals, meds given, fluids given, lab and diagnostic results, etc. are in the chart.

And that's great and all but I'm not sure where in there you as the nurse handing off the patient is confirming that the nurse you're handing off to received and understood the report. I get frustrated too trying to get a hold of a floor nurse sometimes, but if time is the only concern why even spend the time to write the SBAR, just send them up. I put in some work on patients in the ED, if that information isn't properly communicated to the next person caring for the patient then it sort of makes my role in the ED somewhat pointless.

Time isn't the ONLY concern, but it is a big concern. Not just to the hospital, but also to the patient waiting to go up (a big pt satisfaction concern) and the patients in the ED waiting room.

The results of your work is documented in the chart. The floor RN can see what they need to know. What else do you have to offer?

Specializes in Emergency Medicine.
I posted a similar topic almost 2 years ago, I work at a large magnet/ trauma center that newly implemented SBAR paper reports instead of a verbal handoff… it lasted a few months and we went back to calling report. There has to be give and take on both ends, the floor can't stall report and the ED can be understanding and willing to compromise for a timely report. There are a lot of factors that need to be taken in for this system, largely patient acuity and staffing. I don't doubt that a paper report system can work when appropriate, but for a large, high acuity medical center- we were unable to make the change. Same issues tend to occur when PACU is trying to call report for their patients to the floor, when there is compromise and understanding on both sides- it works!

I work at a large level 1 trauma center- this process has worked for us. But it's also about how changes are implemented and how quickly issues are identified and can be corrected, to make these changes successful.

I worked PRN at a place that did this. They faxed a basic sheet...which was always wrong...and would just show up with a pt., drop them and say good luck! Pt. never able to give info., and no family. Admitting diagnosis something like altered mental status. Pt would be drug crazy and needing 4 points. No orders and no nurse willing to give info when I would call for an actual report. Just read the paper. Nurse to nurse report is, for me, a professional duty. I can tell you way more than that paper ever will.

Since you asked, yes, this did actually happen, and yes, I am working on a research project that will hopefully change the current way we do things to something better. I totally understand your side of the fence where some nurses refuse to answer the phone to receive report, all in an effort to stall an admission. Nevertheless, I believe that this still does not void the need for verbal handoff. Standard handoff procedures were implemented and required because poor patient outcomes, sentinel events and patient dissatisfaction have all been proven to occur without them.

Honestly, the real issue does fall back on adequate staffing. I know if I am running with a group of six high-acuity patients I barely have time to get my work done let alone admit a new patient to the unit right before change of shift. We all need more help.

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?

I always say this too. If the er is not required to give me an update on the patient than why do we still do shift report? Our er faxes a sheet that really has no real info on it. I would much rather leave at 7 then sitting around waiting to give report every shift. I mean they can just look in the chart right. That's what the powers to be assume about er to floor hand off.

Specializes in Med/Surg crit care, coronary care, PACU,.

On epic, we can SBAR patient updates. Most of our floor nurses are expected to read the SBAR, then do a safety hand off in each room with the oncoming nurse. In emergency response I find many nurses have no idea of goings on during hospitalization, and safety hand offs are just not viewed as important. Is quite upsetting to follow up on Rapid Evaluation, falls, hypoglycemic episodes, or even a change in condition where I was involved in the evaluation, and find the new nurse had no idea something significant happened to their patient. Not only that, but I know more about their patient's history than they do. I believe hand off reports that are not done according to minimal standards open up not only the nurse and hospital to litigation, but can impose significant risk to our patients.

I always say this too. If the er is not required to give me an update on the patient than why do we still do shift report? Our er faxes a sheet that really has no real info on it. I would much rather leave at 7 then sitting around waiting to give report every shift. I mean they can just look in the chart right. That's what the powers to be assume about er to floor hand off.

Well, when the two nurses involved are right there on the same floor in the same area, and there is no patient flow issue related to nurses trying to catch each other on the phone, it would be silly to not do a verbal report.

And, obviously a chart for a person who has been admitted for a day, week, or month is much longer then the ED chart which amount to a few hours of care dedicated to one or two problems.

That being said, when I was on the floor (which thus far has been 4 1/2 years of my 5 years in nursing) many nurses reports were too long.

Specializes in Med-Tele; ED; ICU.

I work in a large academic medical center and this has been the policy for years and, while some nurses complain about it, it hasn't resulted in any documented adverse outcomes. A customized handoff report sheet contains all the pertinent information. If, as occasionally happens, something didn't get charted then the receiving nurse can call with questions. This happens almost never... and when it does, it usually pertains to I&Os, some of which can be found in the MAR.

I also work at a facility which mandates phone report. Probably 50% of the time, the receiving nurse isn't available for report when I call and the patient dwells... and another ED patient needlessly waits to see a doc.

When I do call report, I give them a quick summary: "Jimi Hendrix is a 34 year old man who presented 4 hrs ago with acute abdominal pain and nausea. Based on his labs and imaging, they're diagnosing him with acute pancreatitis. His nausea was controlled with Zofran and his pain has responded well to the Dilaudid that we've given him. His last set of vitals was WNL with an SBP in the 120's and a heart rate in the mid-80's. He knows that he's NPO but has been continuing to request food and water... probably going to be an ongoing issue with him. Questions?"

Often times they follow with requests for details about his labs (um, look at the results yourself), IV access (they're charted... and easy to find if you follow the tubing from the bag of maintenance fluids), what we've given him (I just told you... zofran and dilaudid; if you want the details on times and doses, look at the EMR), and even the admitting orders (I don't delve into those unless I'm keeping him... )

And here's the thing: What I tell you really means nothing... if I give you wrong information or incomplete information, you're still going to be held accountable for what's in the chart, not what I told you.

And keep in mind: I may have had very limited interaction with the patient and may not know much more than you do.

Full disclosure: While I am a full-time ED nurse, I also float to the various ICUs... I know what it's like on both ends... and I steadfastly maintain that the EMR is the definitive source of information, not a verbal report.

Specializes in PCCN.
How does the receiving nurse ask a question of a faxed piece of paper?

I think the whole point is so we dont ask questions,as that holds up the bed assembly line.

Specializes in med-surg, IMC, school nursing, NICU.

At my last hospital job, if the pt was coming from the ED we got a system-by-system faxed report. The ED nurse would call about 7 seconds after it was faxed and ask if we had any questions or explain anything that might be unclear. The PACU called up regular old report on the phone. The fax and call method was pretty nice, I didn't mind it.

Specializes in Family practice, emergency.

Our policy is to send a written report and call in 15 minutes to tell them that they are coming. The responsibility lies on the floor nurse to call with questions. I usually try to call and catch the nurse to make sure there are no questions. This can be somewhat repetitive and wastes time because I get questions that are clearly on the SBAR. However, most of the time it facilitates a positive relationship that ultimately benefits the patient. There will always be the 3% that are looking for a way to keep the pt in the ED, and likewise on our side the 3% who are sending the pt up before completed orders or ensuring full safety. The verbal can be a lifesaver in these instances.

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