# How to properly give an ER report to nurses.



## ochacon80 (Aug 9, 2009)

I am a month in to my new job and so far so good. My boss is happy with my progress and I feel more and more confident as the days go by. I have noticed though a trend developing. I have heard a lot of my co-workers have been getting chewed out for not reporting to nurses properly. I have yet to give one, but when I do, I want to make sure im doing it properly. I was taught that you give pt. Age, sex, CC, pertinent info regarding the CC and Vitals, and then ask the nurse if they want to know anything else. Is this correct? I am in LA County if this helps.


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## Shishkabob (Aug 9, 2009)

All depends on your company's policies on it, so your best bet is to ask a supervisor, your FTO, or someone else higher up.


But yes, that tends to be what it is.


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## KillTank (Aug 9, 2009)

ochacon80 said:


> I am a month in to my new job and so far so good. My boss is happy with my progress and I feel more and more confident as the days go by. I have noticed though a trend developing. I have heard a lot of my co-workers have been getting chewed out for not reporting to nurses properly. I have yet to give one, but when I do, I want to make sure im doing it properly. I was taught that you give pt. Age, sex, CC, pertinent info regarding the CC and Vitals, and then ask the nurse if they want to know anything else. Is this correct? I am in LA County if this helps.



ER Reports are cake (as long as you take the time to get all of your patients past history and info) I do have a tendency though to be a smartass to the RN's in the ER when they start yelling at me for more info.


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## JPINFV (Aug 9, 2009)

For a face to face report, something along the lines of,

"Good morning. This is [patient name]. He/She's a X y/o coming from/was [specific or general.] where he [history of present illness including pertinent hx, allergies, medication]. Exam info including vital signs. Treatments, changes in condition, response to treatment, etc. Any history/allergies/medications not given earlier. Questions?"  If the nurse is filling out the hospital chart, also give demographics like PMD, DOB, etc since you probably have it written down on your chart already. 


So, example.

"Good afternoon. This is John Doe. He's 60 years old with a history history of an MI in 2005 and CHF and started developing difficulty breathing approximately 15 minutes ago while shopping at Vons [supermarket]. On arrival, he was breathing fast and shallow with accessory muscle use. He complained of severe congestion, difficulty breathing and had a productive cough while denying other pain. On arrival he's blood pressure was XX/YY, breathing at 40 times a minute with a pulse of 100. He had pale, damp skin signs. We placed him on a nonrebreather at 10LPM with some improvement and started transport without medics due to a short transport time. There was no additional changes during transport. Any questions?"


The important thing is to hit at a minimum all of the major positive and negatives of your assessment, all of your treatments, and most to all of the minor points. Developing your own flow is more important than following someone elses since if you're giving the impresson that you don't know how to give report than the nurse has no reason to trust your assessments, treatments, and judgments.


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## MSDeltaFlt (Aug 9, 2009)

ochacon80 said:


> I am a month in to my new job and so far so good. My boss is happy with my progress and I feel more and more confident as the days go by. I have noticed though a trend developing. *I have heard a lot of my co-workers have been getting chewed out for not reporting to nurses properly*. I have yet to give one, but when I do, I want to make sure im doing it properly. I was taught that you give pt. *Age, sex, CC, pertinent info regarding the CC and Vitals, and then ask the nurse if they want to know anything else*. Is this correct? I am in LA County if this helps.


 


Linuss said:


> All depends on your company's policies on it, so your best bet is to *ask a supervisor, your FTO, or someone else higher up.*
> 
> 
> *But yes, that tends to be what it is*.


 
You can also ask the nurses how they want it.  Get a concensus.


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## WuLabsWuTecH (Aug 9, 2009)

Are you talking face to face, or over the radio?

Also a trauma room report is going to be a bit different because everyone is quiet and listening to YOU.  So since when you're giving report no one can talk until YOU are finished, it has to be more clear and concise while at the same time through so after you're done not everyone is trying to ask you questions.


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## VCEMT (Aug 9, 2009)

When giving a report, always look at the nurse as you are talking to her/him. Don't look at your paperwork while giving a report. 

This is a layout of how I do it:
Age
Sex
A/O
C/C
V/S
Tx
Past Hx


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## Sasha (Aug 9, 2009)

Face to face I do them like this: Who you have. What's Wrong. What You Did. How they responded. Pertinent PMHX, Meds, and allergies if they ask. However I'm also toting a patient chart with all that info to hand off.

Over the radio I always gave them a chief complaint, stable or not, and ETA. That's all they really wanted.


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## Dominion (Aug 9, 2009)

It depends on your area as well.  With some triage here I've had to fight with them (not literally) to get them to pay attention to me and not ask the patient.  Just some triage won't listen to EMS, it's frustrating to tell her something and then have her turn around and ask the patient and get the same answer.  Some nurses are really cool with reports though and will cut and crack jokes while you're giving your infos.  

For radio reports, quick and concise.  If you're long winded good chances are the doc has dropped the handset and is walking around.  I've always called in:
Medical: CC, What we did, current status, eta, and any questions or orders
Trauma: How found, what we did (not a 10 min run down but the important points), current status, eta, any questions or orders.

Never had any complaints so far.


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## 46Young (Aug 9, 2009)

If you try to give too much info, you'll lose their interest. Go with age, sex, mental status, chief comlaint, any significant findings (Cx pain, rales, significant injury/MOI), V/S, O2 therapy and any drugs/interventions, ETA, "Any questions or orders"? That should take less than 30 seconds. If the RN needs more info, they'll ask. 

Example: Male, 44, A&O3, Hx of asthma and HTN, C/O dyspnea for several hours, wheezing and diminished L/S bilaterally, unable to speak full sentences. 144/88, 92, 30, one albuterol treatment with 6 lpm O2 with some relief, no ALS available, ETA 6 minutes. Questions or orders?


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## ResTech (Aug 9, 2009)

I don't think there is a defined "proper" way to give a nurse a report. Just give the nurse the run down of what ya got... try to be as systematic and pertinent as possible and keep in mind that some nurses are *****es so no matter how well you give a report u will still get attitude.


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## NomadicMedic (Aug 10, 2009)

Here every hospital is different.

For example, with radio/phone reports, one hospital just wants Chief Complaint and Age. Another wants a full run down. 

At the Hospital when we give report, one ER wants us to read them the PTs info in a very specific order so they can enter them into the computer, THEN you give report.

At another hospital, you only give report to the RN and ignore the techs that ask you questions, lest you get chewed out by the Charge.

At yet another hospital, you give report to the RN and then an abridged version to the Doc.

And each one wants/needs your paperwork at a different time. Some demand a copy of your PCR the minute you walk in, others don't care.

When I go to a new facility, I've found it's best if I just ask "How do you want report from me?" I know most of the triage nurses at the ERs I frequent, so now it's no big deal if I do it in the wrong order. 

If you tell the RN "it's my first time here..." they'll cut you some slack.


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## JPINFV (Aug 10, 2009)

n7lxi said:


> At yet another hospital, you give report to the RN and then an abridged version to the Doc.



Abridged report? Every single time I've given a report to a physician the report consisted of age and C/C, and that, strangely enough, was the only thing the physicians wanted.


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## firecoins (Aug 10, 2009)

In person or over the phone?  I ask because if I bring in a patient, they can clearly see the gender of the person and get a rough estimate of the person's age.  

In person I start with the name of the patient, CC and history of said CC, vitals and medical hx.


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## mycrofft (Aug 10, 2009)

*FInd out the required basics and meet them*

Some people can't get enough report, some cut you off.

Allergies, name, c/o, timeframe, place found or originating facility, and payment source if known. (Home meds are *nice* too, especially if you actually bring them or have a legible list with type, dose, freq., how long has been taking and how faithfully).
Oh, yeah...anything you did enroute or on scene is good ideaB)


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## firecoins (Aug 10, 2009)

n7lxi said:


> If you tell the RN "it's my first time here..." they'll cut you some slack.



that runs out quick when your brining in your 5th patient to the same hospital in a shift.


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## Medic744 (Aug 10, 2009)

For me it depends on hospital, pts problem, and the nurse.  Everyone wants something different and some of them dont even want to talk to you at all.  I do a quick run down of age, cc, history, and what I did along with vitals and ask if they want anything else, collect my signatures and go about my day.


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## BossyCow (Aug 10, 2009)

This will totally depend on who you are giving the report to. We have one ER doc who asks for the report by saying "Tell me a story!" and another who only wants DOB, Gender and CC. We have one ERT who makes it a point to ask for one detail you haven't given. For a short time, I tried to anticipate the questions but then the questions just got more and more obscure. But, to avoid starting an ego war, I either answer or tell the ERT that I'll have that info for them when I arrive.


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## Melclin (Aug 10, 2009)

Like everyone else has said it depends on where you are. Basically, find the person that will be doing any yelling, and find out what they want.

Otherwise. As a basic guide MIST is a good acronym to go by. It's a guide for trauma radio briefs, I've found it helpful in the early stages of learning how to prioritize information.

Age, Gender, Name (if in person)

*M*echanism of injury.
*I*njuries/Illnesses (starting with CC)
*S*igns & symptoms (including results of VSS)
*T*ime (as in ETA, extrication times etc) & treatments given


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## nomofica (Aug 12, 2009)

To change up the MIST idea, this is how I was taught (for radio)

OCHAT

Onset
C/C
Hx
Assessment (vitals, general impression, MOI, etc, etc)
Time (ETA)


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## paramedichopeful (Aug 13, 2009)

I found this thread to be very educational. We are yet to get to this part in class, but I want to be sure I know how to give an accurate report in a timely manner. Ha, maybe when we finally start on this in class, maybe I will have a bit of an edge!! When we ride with Medics for observation time for our class, they always take the pt. in and go into the ER first. We simple students follow and listen and watch. The way the Medics here do it is 90 mile an hour, and very rarely do the nurses have any questions. They usually get all the information across very accurately and very quickly. Guess that's something that comes with years of experience, though.


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## NomadicMedic (Aug 13, 2009)

firecoins said:


> that runs out quick when your brining in your 5th patient to the same hospital in a shift.




Agreed. That's why it only works the FIRST time you're in a new facility.


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## NomadicMedic (Aug 13, 2009)

JPINFV said:


> Abridged report? Every single time I've given a report to a physician the report consisted of age and C/C, and that, strangely enough, was the only thing the physicians wanted.



That just shows it's different everywhere you go. One ED I frequent has docs that actually want to hear our story.


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## Melclin (Aug 13, 2009)

paramedichopeful said:


> I found this thread to be very educational. We are yet to get to this part in class, but I want to be sure I know how to give an accurate report in a timely manner. Ha, maybe when we finally start on this in class, maybe I will have a bit of an edge!! When we ride with Medics for observation time for our class, they always take the pt. in and go into the ER first. We simple students follow and listen and watch. The way the Medics here do it is 90 mile an hour, and very rarely do the nurses have any questions. They usually get all the information across very accurately and very quickly. Guess that's something that comes with years of experience, though.



I always found it was a nice idea to be quite familiar with the concepts before the class. Even if it feels like you're going over stuff you know, you already know some of the problems you have in understanding the issue, and can ask all the questions you would have ended up coming up with at home a day after the lecture, had you not been well informed beforehand. And if you're like me and are trying to earn academic brownie points to try to get in on research projects, then it helps with that too :blush:


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## wyoskibum (Aug 13, 2009)

Ahh, it depends on the nurse receiving the report...........

For my radio patches, I always start with ETA & C/C. IE: Medic One is 10 mins out with 55 y.o. female c/o etc.....  and finish with "Any questions or instructions?"

For the bedside report, I ask them if they got the radio patch.  If not, they get the whole story and before I leave, I always ask "Do you need anything else from me?"


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## marineman (Aug 13, 2009)

Ask the nurses, out of the 4 main hospitals I transport to they all want something a little different, and typically for critical patients they prefer a phone call rather than radio if you can. They prefer phone over radio on all calls but especially on criticals so they can get the patients full information and have their medical history up and review it before you get there. 

With that said I have 2 versions of a radio report, gives the hospital a very good idea how to prepare. 

First version is a non-critical patient called in via phone. My name, ambulance number, patients age, sex, DOB, and full name. Then move into c/c, pertinent assessment findings, interventions, then a set of vitals. Seems like a bit but once you get it down it takes less than 45 seconds. 

For a critical patient I usually use the phone still unless we're really up a creek. I will call, and first thing I give is c/c (Trauma, CVA, Cardiac), then patient age and sex, then if I have time and I know I will give them DOB and a Name. 10 seconds or less on this call, they don't need to know all the nitty gritty details if you have other things to do as long as you let them know roughly what's coming in so they can plan, they're going to do a full assessment at the hospital anyway so save the details for your face to face report. 

Another way I have seen notification done (this we only do with trauma alerts) is we will call the hospital on the way to a scene if it sounds bad and let them know anything we've gotten from dispatch. Then once we're on scene we give a call whenever we get a free hand (this is usually by radio) to let them know it's a trauma alert. Then we call (again on the radio) with an ETA. If we can get an age and gender that's cool if not too bad, they prefer to know if it's a peds patient but anything else they understand.


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## paramedichopeful (Aug 15, 2009)

HA! After class today I asked my instructor what we were going to do next week. You guessed it! Run reports and proper procedures for a run. And yes, the ER report IS in that part!!! Thanks guys for sharing your advice and wisdom!


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## Level1pedstech (Aug 17, 2009)

As with most questions you will get a different answer from almost everybody. I can give you our ER teams view and you can funnel out the other information combine it with your clinical observations and hopefully be able to give the ER what they need.

 HEAR(radio) Reports.

 The main reasons for the radio report are to allow us to plan for your patient. We need to know the acuity level so we can make sure that the patient gets to the right place trauma room, direct to OR, direct to L+D,to peds ED,direct to triage or just a regular room or in a full house situation where in the hallway to take up some turf. Our radio log reads as follows Unit #, inbound code,ETA,age,M,F,CC,vitals w/GCS,interventions and any other questions. The big goal here is to let us know what to expect in a short clearly spoken well delivered report. Long drawn out reports may make you feel like your helping but to be honest most of us only need the above information to make our initial determination on where to put your patient if we need more information we will ask for it.

 Report to RN

 On arrival you should have a room or location to take the patient, I said should. This wont always be the case but that's life, I just know some wise guy will have to post that their ER never has a room or drone on and on about their horrible treatment at the hands of the ER team. You may first be greeted by an ER Tech,we will help you transfer your patient and ask for a little information, this is not the report you give to the RN its just so we can determine what the patients needs are (monitor,initial vitals, EKG). It helps us get the patient settled in while waiting for the RN. When the RN arrives you will give your big report, this will include all the details and history pertinent to the patients visit. I'm not an RN and I don't take that report so I will leave it at that. I can tell you that most of my RN's treat the incoming medic crews with the respect they deserve and having an attitude will get you know where. We all have bad days but this is serious business folks so leave your problems at the door. Some of the young ones just getting into EMS need to learn show respect and some of the older ones need to re-learn the meaning of the word. 

 I just wanted to give you a little insight into what we like, Im sure you will hear plenty of horror stories about the ED's but think of it this way, at least you get to leave when all hell is breaking loose. Remember we all want the best for our patients and sometimes quality health care comes with a wait. If there are any ER RN's or techs that have any thoughts please feel free to add your two cents.


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## NomadicMedic (Aug 18, 2009)

I just saw a good blog post at The EMT Spot making mention of a study at Harvard that tracked pre-hospital info in triage reports and how to make sure the "important stuff" gets noticed and charted. 

You can read it HERE. It's quick and good info.


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## medicdan (Aug 18, 2009)

My guage of the quality of the report I give is whether the nurse has any questions at the end. The worst possible outcome is when the nurse has to ask the patient a question, that either I did ask, or didnt mention in the report.


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## Melclin (Aug 18, 2009)

emt.dan said:


> My guage of the quality of the report I give is whether the nurse has any questions at the end. The worst possible outcome is when the nurse has to ask the patient a question, that either I did ask, or didnt mention in the report.



To be fair though, a lot of questions get asked again along the lines of double checking.... If you were to tell the nurse the pt has no allergies, and they ask the pt if they have any allergies...I wouldn't get too down about it.



> I just saw a good blog post at The EMT Spot making mention of a study at Harvard that tracked pre-hospital info in triage reports and how to make sure the "important stuff" gets noticed and charted.
> 
> You can read it HERE. It's quick and good info.



Great article. Tremendously interesting reading and very satisfying to see some objective evidence for a problem we all know is a pain in the arse. Cheers for that.


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## Level1pedstech (Aug 18, 2009)

I think the article was good also. I will be the first to admit that we in the ER are guilty of not charting perfectly all the time. If I am recording on a level one trauma at 0630 my charting might not be as sharp as it was at 1930. Fortunately between myself and the rest of the trauma team we manage to get a complete chart ready to follow the patient through the system. Another example might be an RN who has a full pod of high need patients 11 hours into thier shift might not get every last bit of what would be considered a stellar report. I don't think it rises to the level of negligence by any ones measure but shows that we are all human and sometimes one person may need to pick up the extra slack. 

 I do have a little story about a medic who gave what could only be described as a truly stellar report but it went on way to long. This was a level 2 trauma transfer from another facility, on arrival the medic started giving his report. Everyone was listening quite intently to his very descriptive report when a few minutes into it he started getting really technical about the vehicles involved and the extrication methods used on scene. He had already given us more than enough to work with but began to lose the interest of the others in the room when he started talking about A posts and B posts. Being a fire guy and having ripped up a few cars in my time I was very interested and we moved back into my little corner of the trauma bay where he went on for a few more minutes never breaking stride or pausing to collect his thoughts. I'm not sure if he realized it was just him and I but I had to cut him off at that point because assessments were under way and I needed to chart. I think it was the best report I have ever had.


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## Melclin (Aug 18, 2009)

level1pedstech said:


> i don't think it rises to the level of negligence by any ones measure but shows that we are all human and sometimes one person may need to pick up the extra slack.



amen! 



10 char


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## Sasha (Aug 18, 2009)

> My guage of the quality of the report I give is whether the nurse has any questions at the end. The worst possible outcome is when the nurse has to ask the patient a question, that either I did ask, or didnt mention in the report.



It's just a safe guard, and sometimes they ask the question in a different way than you did. How many times have you had a patient that you asked "Are you in any pain? Do you hurt anywhere?" and they say "No." then someone else asks and you get a "You know.. I do have this pain right here...." Or "Are you allergic to anything?" "No.." asked later "No.. oh wait.. yeah".


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## Melclin (Aug 18, 2009)

My goodness, Sasha, I could be forgiven for thinking you were agreeing with me....


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