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

Nurses General Nursing

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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?

Specializes in Telemetry.
You might like to know, but it isn't a priority.

But I bet the pt who has been on a hard gurney would like to have an appropriate bed when they get to the floor (or soon after)

Yes in the ED you prioritize to stabilize but on the floor we have so many things to do at once or within certain time constraints and we can't exactly pause our other patients.

I would like to work in the ED sometime so I try to be respectful but quite frankly in this and other current threads I *feel* like ED nurses are implying they have it harder than anywhere else and thier jobs are more important. And yes it is vital to get them stable but some understanding of what the unit and floor nurses go through wouldn't hurt.

But I bet the pt who has been on a hard gurney would like to have an appropriate bed when they get to the floor (or soon after)

Yes in the ED you prioritize to stabilize but on the floor we have so many things to do at once or within certain time constraints and we can't exactly pause our other patients.

I would like to work in the ED sometime so I try to be respectful but quite frankly in this and other current threads I *feel* like ED nurses are implying they have it harder than anywhere else and thier jobs are more important. And yes it is vital to get them stable but some understanding of what the unit and floor nurses go through wouldn't hurt.

I've been a ED nurse for 6 months, abd a med-surg nurse for 4 1/2 years before that. I agree with you, that many ED nurses feel that they have it harder and they are better. I know how hard med-surg nursing is, and I know a solid med-surg nurse is no less valuable then their counterpart in the ED.

However, when we are talking about getting patients safely and efficiently up to the floor (and off that uncomfortable gurney), I would disagree that verbal reports are needed to assess for things like the need of specialty bed or to find out about family dynamics.

Specializes in Telemetry.
I've been a ED nurse for 6 months, abd a med-surg nurse for 4 1/2 years before that. I agree with you, that many ED nurses feel that they have it harder and they are better. I know how hard med-surg nursing is, and I know a solid med-surg nurse is no less valuable then their counterpart in the ED.

However, when we are talking about getting patients safely and efficiently up to the floor (and off that uncomfortable gurney), I would disagree that verbal reports are needed to assess for things like the need of specialty bed or to find out about family dynamics.

Then how do you suggest that information be conveyed so that the equally busy floor nurse can start putting in for a proper bed or see if a sitter can be found if needed?

If floor nurses magically had that info without a verbal report would be one thing but we all know the sbar or faxed report may be lacking.

And as I am sure you remember, once on the floor or unit, everything the pt and family have been waiting for (perhaps a meal if orders not yet in and cafeteria is closed) or their pm meds or who knows what - suddenly it all falls on the floor nurse and the stupid constant fear of press gainey follows them around as they try to get pt settled, orders going and all those non vital things the ED understandably didn't do while making sure pt and family happy with care and of course their other patients.

Just any heads up that could make things safer or go more smoothly would be great.

But again this is a fight all nurses need to come together for and demand proper staffing, equipment, and maybe the ability to explain to patients what they can expect without getting in trouble.

In many places both floor/unit and ED nurses are getting the shaft from mgmt and sometimes the pt will suffer and the nurses will be blamed.

So no pissing contest necessary because we know it is difficult everywhere.

Sorry for rambling but like I said the more inter-department bickering goes on the less chance nurse come together and fight for what is right.

Thanks for letting me say my piece, and thanks to the ED nurses and techs who have some pretty crazy jobs!

Specializes in Med-Surg, OB, ICU, Public Health Nursing.
We started the same thing at my hospital. I work in the ER. and the policy now is if the nurse on tele or med/surg doesn't take report on the first call we send transport. And it is the floors responsibility to call me when they can. It sucks bc I feel bad for the nurses upstairs. We r all busy!! The reason they put this into action is bc a lot of times it would be sometimes 2 hours after a or got a bed assigned. And people r in the waiting room. The ER wants to clear the admitted pts out so fast u don't even have time to breath anymore. It is just nuts. Then on top of it the floor nurses get mad at ME but I am just following our policy. Bc if I don't then management gets on our case if we haven't sent the pt up. It's a loose loose for all. Sorry for my fat fingers trying to type :)

But its policy- breaking policy wil get you fired. Please don't insinuate that what I'm doing is not safe- like I said, in the years we've done it there has NEVER been compromising to a pt or the care they are receiving. Policies are in place for a reason and this is not one I'm going to fight- these policies would never have to be put into place if the floors did not show consistent delay in transfers. We don't have time for delays- people's lives depend on a bed in the ED at times- there is no reason a STABLE pt that has been worked up needs to continue to monopolize a bed in the ED bc the floor does not wish to take report.

If the problem is that the floor is causing a delay, then that should be addressed. There is so much information that is not captured in a fax or a computer printout. Sadly, at times nurses are becoming babysitters for machines. Patients are more than a page full of data.

At the public hospital, where I worked, management tried to implement the fax and no call. Because this was a large public hospital, we had patients who were both medically and socially very complex.

When this was proposed by management, our nurses were horrified. Therefore, the nurses contacted their union called for a "meet and confer" process. This process says nurses have the right to meet with management to discuss a change prior to implementation. For nurses who do not have a union, always express patient safety concerns to management as a group.

The meeting was quite successful and the hospital abandoned the fax proposal. They worked out a different solutions to prevent delays in admitting pts. to the floor.

It is sad to see that we are losing the art of nursing....

Specializes in Med-Surg, OB, ICU, Public Health Nursing.

"Yes, it's about pt safety- most hospitals don't implement changes that hinder pt safety."

You have got to be kidding!!! Managers (who are not nurses, or nurses who haven't worked at the bedside for years but "efficiency experts") come up with all kinds of crazy ideas that can and do endanger patient safety. If hospitals didn't implement changes that hinder patient safety, then every hospital in the US would be appropriately and safely staffed.

We wouldn't need laws, ratios, contracts etc. We wouldn't have thousands of conversations about profit versus patient care.

Specializes in Med-Surg, OB, ICU, Public Health Nursing.

Interesting article. See examples of communication breakdown.

Handoffs: Implications for Nurses - Patient Safety and Quality - NCBI Bookshelf

Part of the solution during the meet and confer was to establish "transport nurses." This addressed preventing delay in transfers and getting a complete report. Bottom line, it is all about staffing.

FYI,

"The Joint Commission requires all health care providers to 'implement a standardized approach to handoff communications including an opportunity to ask and respond to questions' (2006 National Patient Safety Goal 2E). The Joint Commission National Patient Safety Goal also contains specific guidelines for the handoff process, many drawn from other high-risk industries:"

(found at the bottom of the article link listed above)

Specializes in Emergency, Trauma, Critical Care.

We have a handoff note in the chart, it gives all the important details we'd want the floor nurse to know. ICU pts still get report called and primary RN travels with. The one exception for floor patients is stroke so you can compare their stroke scale. The reality in ER is we only have these patients a few hours and our jobs are all the tasks and frequently we don't have time to get an extensive history etc and the expectation is the floor nurse will be able to further evaluate the pt. two busy nurses trying to find a good time to communicate report can be near impossible. if you have an unstable patient in the ER where you can't get out of the room it hasn't been uncommon for another nurse to do the handoff for you to get the stable patient upstairs. With a charted handoff note by the primary RN that's probably better than a lot of the verbal reports we are able to give in the ER.

No report from ER is pure insanity, and utterly dangerous. Half the pts come up before "30 min" because ER wants to push them out. Half the time they have squat for orders, aren't stable at all, can't give a history, etc. I don't care how long you have to wait for a floor nurse to pick up for report. If I'm too busy to take report I'm likely to busy to accept a trainwreck admission right now! /Rant but seriously the come up, no orders but on 02... Diabetic and no orders for anything with a big of 45 or 450. Screaming in pain, no orders, etc. It's a very dangerous practice. We are forced to do time consuming bedside report because laying eyes on the pt and getting good info is so important to safety but now we're getting a surprise admission and no info usually? Unsafe, unsafe, unsafe.

No report from ER is pure insanity, and utterly dangerous. Half the pts come up before "30 min" because ER wants to push them out. Half the time they have squat for orders, aren't stable at all, can't give a history, etc. I don't care how long you have to wait for a floor nurse to pick up for report. If I'm too busy to take report I'm likely to busy to accept a trainwreck admission right now! /Rant but seriously the come up, no orders but on 02... Diabetic and no orders for anything with a big of 45 or 450. Screaming in pain, no orders, etc. It's a very dangerous practice. We are forced to do time consuming bedside report because laying eyes on the pt and getting good info is so important to safety but now we're getting a surprise admission and no info usually? Unsafe, unsafe, unsafe.

I would say that the issues you speak of are bigger then verbal report vs chart review/written report.

If the problem is that the floor is causing a delay, then that should be addressed. There is so much information that is not captured in a fax or a computer printout. Sadly, at times nurses are becoming babysitters for machines. Patients are more than a page full of data.

At the public hospital, where I worked, management tried to implement the fax and no call. Because this was a large public hospital, we had patients who were both medically and socially very complex.

When this was proposed by management, our nurses were horrified. Therefore, the nurses contacted their union called for a "meet and confer" process. This process says nurses have the right to meet with management to discuss a change prior to implementation. For nurses who do not have a union, always express patient safety concerns to management as a group.

The meeting was quite successful and the hospital abandoned the fax proposal. They worked out a different solutions to prevent delays in admitting pts. to the floor.

It is sad to see that we are losing the art of nursing....

So, what caused the "horror" among the nurses?

No one has been able to say, with specificity, what bad things happen when there is a process put in place for the nurse to receive a written report or opportunity to review the chart vs verbal reports.

Interesting article. See examples of communication breakdown.

Handoffs: Implications for Nurses - Patient Safety and Quality - NCBI Bookshelf

Part of the solution during the meet and confer was to establish "transport nurses." This addressed preventing delay in transfers and getting a complete report. Bottom line, it is all about staffing.

FYI,

"The Joint Commission requires all health care providers to 'implement a standardized approach to handoff communications including an opportunity to ask and respond to questions' (2006 National Patient Safety Goal 2E). The Joint Commission National Patient Safety Goal also contains specific guidelines for the handoff process, many drawn from other high-risk industries:"

(found at the bottom of the article link listed above)

Someone else posted this earlier. Since when do we always agree with The Joint Commission...lol!

I don't know what to tell ya, except that as evidenced here, many institutions have some sort of no verbal report process in place, and seem to be in compliance with TJC and CMS standards.

Specializes in PACU, pre/postoperative, ortho.

This is one of those subjects that comes up over & over where you just have to agree to disagree. I personally prefer a faxed sbar on the receiving end.

-Shift supervisor calls for bed placement with pt name, dx, admitting & consulting doc info (usually 30-60 min before pt comes up to floor)

- We have access to pt's charting if time allows prior to sbar (charge rn will often look up the er notes unless she has her own pt assignment)

- Sbar is faxed up with a phone call to ensure it is received. It includes presenting complaint, dx, vs, allergies, past hx, med rec, meds given in er, iv access, orders, etc. (What else do you need?) At the time of the phone call to alert that the fax is sent, any additional info (family dynamics, personality issues, etc) is passed on if necessary.

- Pt comes up about 15 min after sbar.

We do the same when sending post-op pts from pacu to the floor. Fax the sbar & send the pt up 15 min later. Phone reports are only given with peds & ICU. I've never had an issue myself with this from either side of the fence.

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