Share handoff info that's not in the patient's chart

Small details can be important

Would you think to tell a receiving nurse that your ED patient has a dog at home she's worried about? That may be the reason she's refusing admission, says Pat Clutter, RN, MEd, CEN, FAEN, an ED nurse at St. John's Lebanon (MO) Hospital.

"There are often small items of detail that get left off of a charting process, especially in these times of 'charting by exception,'" says Clutter. These may include the family dynamics, home arrangements, or stressful situations, she says.

"All of these things can impact how that patient is handling the ED visit or the upcoming inpatient stay," says Clutter. "'Idle chit-chat' while starting intravenous lines or taking vital signs really provides us with vital information."

Even as you focus on the patient's chief complaint, says Clutter, you're also providing holistic care. "That means that we listen closely to our patients. We elicit information that might help us assist them even better," she says. "Sometimes, one small statement made by a patient is the crux of an entire issue."

You may learn that a patient is refusing admission because there is no one to care for his or her dog, says Clutter. "When giving a report, whether it is to an oncoming ED nurse or to the inpatient department, share all the information that you can," she says.

If ED nurses grab a chart to "give report and get that patient admitted" without checking with the primary nurse, says Clutter, they can miss out on the important information that must be relayed to the next health care provider. "It might help with patient flow, but it does not necessarily help the patient's true care," she says.

Clutter says that she makes a point of giving verbal reports to the floor nurses herself for her patients. "There is no way that someone can pick up the chart, read a few lines, and get the whole picture like I know it for that patient," she says.

Likewise, says Clutter, a nurse may attempt to give a more detailed report to an oncoming ED nurse who doesn't listen attentively. "If the nurse says something like, 'Yeah, yeah, yeah, I read your chart — I got it,' that does a grave injustice to the patient," she says.

Give a real-time picture

Jean M. Boles, RN, MSN, an ED nurse at Penn Presbyterian Medical Center in Philadelphia, says that ED nurses used to give a written faxed report, but now give verbal reports because "a real picture can be painted. Also, it is in real time."

For example, says Boles, you might tell the receiving nurse about any issues that might make it difficult to treat the patient. By giving a verbal report, says Boles, "you converse with the receiving nurse. It is not just a monologue but a dialogue, with gut feelings of illness and also a little bit about the person in general."

Sources

For more information about handoffs of ED patients, contact:

  • Jean M. Boles, RN, MSN, Staff Nurse, Emergency Department, Penn Presbyterian Medical Center, Philadelphia. Phone: (610) 291-4555. E-mail: Jean.Boles@uphs.upenn.edu.
  • Pat Clutter, RN, MEd, CEN, FAEN, Emergency Department, St. John's Lebanon (MO) Hospital. Phone: (417) 736-2203. E-mail: prclutter@gmail.com.

Clinical Tip

Need results urgently? Pick up the phone

When Jean M. Boles, RN, MSN, an ED nurse at Penn Presbyterian Medical Center in Philadelphia, is caring for a cardiovascular patient with stat diagnostic results needed, she makes a point of calling for a CT scan and vascular technicians to "paint a picture." "Unfortunately, they only see a name on the computer. You don't want to rely on a computer to prompt the tech," she says.

For example, Boles may tell the technician that the patient had a negative fast-stroke assessment, lower extremity numbness, and was recently discharged for carotid surgery. "In urgent situations, you need to pick up that phone and give a mini-report to expedite the diagnostics," she says.