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Handoff questions: More important than you think?
Don't assume information is irrelevant
Do you ever get frustrated answering questions asked by inpatient nurses about your ED patient, as they seem unimportant to you?
"As ED nurses, we are trained to rapidly assess and react," says D.D. Fritch-Levens, RN, BSN, an administrative resource nurse in emergency services at Children's Healthcare of Atlanta. "ED nurses are not always aware of what goes on in an inpatient area. We are unable to predict the information that is important to the receiving nurse."
Remember that the receiving nurse is more "forward thinking" in the plan of care than you are, says Fritch-Levens. "The ED nurse has two or three hours with each patient, while the inpatient nurse often has days," she says. "The information that is requested is important to the inpatient nurse, even though it might not be critical to the care of the patient while in the ED."
In fact, questions asked by receiving nurses may seem completely unrelated to the patient's diagnosis or treatment, such as, "When was their last meal?" or "When was their last bowel movement?" says Deborah A. Keim, BSN, RN, MICN, an administrative nurse in the emergency department at University of California — Los Angeles (UCLA) Medical Center. "I may not know the answer, and it may have no relevance to the patient's admission," she says.
In this case, Keim says she questions the inpatient nurse to understand what he or she is getting at. "From the inpatient perspective, there is nothing worse than an ED nurse who doesn't know their patient and who doesn't help you get a full picture."
To improve handoffs with receiving nurses, do the following:
• Make it easy to reach you.
When handing off patients from the ED to inpatient floors, it might be a challenge just to get the receiving nurse on the phone, or vice versa. "You both are forever a moving target. Neither may have time to just drop what they are doing when one decides to call report," says Keim. "Just getting the right person on the other end when you finally have time to make the call is sometimes problematic."
At Children's Healthcare of Atlanta, the patient's medical report is sent via tube station to the receiving nurse as soon as a bed has been assigned. "Then, the receiving nurse is given the direct phone number of the ED nurse to allow for questions," says Fritch-Levens.
• Tailor the type of handoff to the individual patient.
For "noncomplex" patients handed off at Children's Healthcare, a written report is sent to the receiving nurse, but this report isn't sufficient for patients with a more complex medical or social history. For those patients, the receiving and ED nurse talk by phone.
Report is given in person for intensive care unit and operating room patients, or if a phone report is given, an ED nurse always escorts the patient to the receiving nurse. "When a patient's clinical care or history is more complex than what can be easily documented on one piece of paper, it is important to know that the receiving nurse understands this," says Fritch-Levens.