How to properly give an ER report to nurses.

ochacon80

ochacon80

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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.
 
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.
 
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.
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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.
 
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.
 
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.
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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.
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You can also ask the nurses how they want it. Get a concensus.
 
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.
 
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
 
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.
 
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.
 
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?
 
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.
 
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.
 
n7lxi said:
At yet another hospital, you give report to the RN and then an abridged version to the Doc.
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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.
 
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.
 
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)
 
n7lxi said:
If you tell the RN "it's my first time here..." they'll cut you some slack.
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that runs out quick when your brining in your 5th patient to the same hospital in a shift.
 
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.
 
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.
 
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)

Mechanism of injury.
Injuries/Illnesses (starting with CC)
Signs & symptoms (including results of VSS)
Time (as in ETA, extrication times etc) & treatments given
 
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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