How to properly give an ER report to nurses.

[paramedichopeful]

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.

 

[NomadicMedic]

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.

 

[NomadicMedic]

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.

 

[Melclin]

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:

 

[wyoskibum]

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?"

 

[marineman]

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.

 

[paramedichopeful]

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!

 

[Level1pedstech]

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.

 

[NomadicMedic]

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.

 

[medicdan]

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.

 

[Melclin]

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.

 

[Level1pedstech]

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.

 

[Melclin]

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

 

[Sasha]

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".

 

[Melclin]

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