Comments on: Patient Handoffs from EMS to the ER, a Fictional Case Study (not a rant) http://lifeunderthelights.com/2009/11/patient-handoffs-from-ems-to-the-er-a-fictional-case-study-not-a-rant/ This blog is about EMS, and one Paramedic's quest to make this the profession it deserves to be. Fri, 30 Jul 2010 08:54:16 +0000 hourly 1 http://wordpress.org/?v=3.0 By: edrn76 http://lifeunderthelights.com/2009/11/patient-handoffs-from-ems-to-the-er-a-fictional-case-study-not-a-rant/comment-page-1/#comment-1499 edrn76 Thu, 11 Feb 2010 00:18:44 +0000 http://lifeunderthelights.com/?p=457#comment-1499 I have been in the ER for 9 years now and have observed the realtions between medics and RNs. I am an RN and have the utmost respect for medics. I for one could not do what you guys do in the field. My hat is off to you guys and gals in the field. I recently took over as the Trauma Coordinator for my hospital. One of my first goals was to improve the relations between medics and RNs. I am almost complete with my ride-a-along program here at our facility. I am going to make ED RNs do an 8hr ride-a-long with EMS during peak times. This will be part of their annual check offs and also part of orientation for new hires. I am also trying to talk the RNs to let the medics c-spine package them so they will know what the patient is going through when they are strapped to a board and have a collar around their neck. I think these things will be a real eye opener for some of the nurses. Thanks for the post and keep up the awesome work that yall do! I have been in the ER for 9 years now and have observed the realtions between medics and RNs. I am an RN and have the utmost respect for medics. I for one could not do what you guys do in the field. My hat is off to you guys and gals in the field. I recently took over as the Trauma Coordinator for my hospital. One of my first goals was to improve the relations between medics and RNs. I am almost complete with my ride-a-along program here at our facility. I am going to make ED RNs do an 8hr ride-a-long with EMS during peak times. This will be part of their annual check offs and also part of orientation for new hires. I am also trying to talk the RNs to let the medics c-spine package them so they will know what the patient is going through when they are strapped to a board and have a collar around their neck. I think these things will be a real eye opener for some of the nurses. Thanks for the post and keep up the awesome work that yall do!

]]> By: edrn76 http://lifeunderthelights.com/2009/11/patient-handoffs-from-ems-to-the-er-a-fictional-case-study-not-a-rant/comment-page-1/#comment-973 edrn76 Wed, 10 Feb 2010 19:18:44 +0000 http://lifeunderthelights.com/?p=457#comment-973 I have been in the ER for 9 years now and have observed the realtions between medics and RNs. I am an RN and have the utmost respect for medics. I for one could not do what you guys do in the field. My hat is off to you guys and gals in the field. I recently took over as the Trauma Coordinator for my hospital. One of my first goals was to improve the relations between medics and RNs. I am almost complete with my ride-a-along program here at our facility. I am going to make ED RNs do an 8hr ride-a-long with EMS during peak times. This will be part of their annual check offs and also part of orientation for new hires. I am also trying to talk the RNs to let the medics c-spine package them so they will know what the patient is going through when they are strapped to a board and have a collar around their neck. I think these things will be a real eye opener for some of the nurses. Thanks for the post and keep up the awesome work that yall do! I have been in the ER for 9 years now and have observed the realtions between medics and RNs. I am an RN and have the utmost respect for medics. I for one could not do what you guys do in the field. My hat is off to you guys and gals in the field. I recently took over as the Trauma Coordinator for my hospital. One of my first goals was to improve the relations between medics and RNs. I am almost complete with my ride-a-along program here at our facility. I am going to make ED RNs do an 8hr ride-a-long with EMS during peak times. This will be part of their annual check offs and also part of orientation for new hires. I am also trying to talk the RNs to let the medics c-spine package them so they will know what the patient is going through when they are strapped to a board and have a collar around their neck. I think these things will be a real eye opener for some of the nurses. Thanks for the post and keep up the awesome work that yall do!

]]> By: minnock http://lifeunderthelights.com/2009/11/patient-handoffs-from-ems-to-the-er-a-fictional-case-study-not-a-rant/comment-page-1/#comment-917 minnock Wed, 27 Jan 2010 06:02:18 +0000 http://lifeunderthelights.com/?p=457#comment-917 Sorry that happened - it should never...You are out there first to be attending to the patients, nurses need to listen, respect what you are informing them of. A factual,presentation of the patient chief complaint, medical history, medications and what treatments were administered.<br>Accuracy, accountability and facts help both EMS and ER provide the best possible care for the best possible patient outcomes. Isn't that why we do this?<br>There is a renewed appreciation for EMS when ED nurses do ridealongs. I did several. As a Director of an ER, it is strongly suggested when joining the ER - part of their orientation is a ride along in an ALS unit for a shift. No room for disregard and rudeness in this line of work! Sorry that happened – it should never…You are out there first to be attending to the patients, nurses need to listen, respect what you are informing them of. A factual,presentation of the patient chief complaint, medical history, medications and what treatments were administered.
Accuracy, accountability and facts help both EMS and ER provide the best possible care for the best possible patient outcomes. Isn't that why we do this?
There is a renewed appreciation for EMS when ED nurses do ridealongs. I did several. As a Director of an ER, it is strongly suggested when joining the ER – part of their orientation is a ride along in an ALS unit for a shift. No room for disregard and rudeness in this line of work!

]]> By: Ambulance_Driver http://lifeunderthelights.com/2009/11/patient-handoffs-from-ems-to-the-er-a-fictional-case-study-not-a-rant/comment-page-1/#comment-813 Ambulance_Driver Tue, 03 Nov 2009 16:53:31 +0000 http://lifeunderthelights.com/?p=457#comment-813 I have a saying that I'm fond of: "History never repeats itself."<br><br>I've seen answers change too many times to be offended when an ER nurse or doctor asks the patient the same questions I've just given them the answer to.<br><br>OTOH, the fictional nurse in your fictional case was obviously being a condescending bitch.<br><br>In such fictional cases, I have been known to, hypothetically, give the fictional nurse ZERO information thereafter. I'll hand off the patient, smile ever-so-sweetly at them and say, "They're all yours!"<br><br>If they ask me for information, I make it a point to provide the information... to someone else, preferably while still in their presence. <br><br>We used to have a nurse who wanted to know everything from the patient's favorite color to their Zodiac sign when you called in a pre-arrival report - anything but relevant information. So, when I recognized her voice on the phone, I'd say, "Howdy, Gail! Five minutes out with a bad one!" or when she'd ask why we were bringing the patient to their particular hospital, I'd reply with "Because the zoo is closed and there's nothing good playing at the movies."<br><br>It took about a week for the ER director to buttonhole me and ask why I did that, so I told him. <br><br>Gail is forbidden to answer the ambulance phone now. I have a saying that I'm fond of: “History never repeats itself.”

I've seen answers change too many times to be offended when an ER nurse or doctor asks the patient the same questions I've just given them the answer to.

OTOH, the fictional nurse in your fictional case was obviously being a condescending bitch.

In such fictional cases, I have been known to, hypothetically, give the fictional nurse ZERO information thereafter. I'll hand off the patient, smile ever-so-sweetly at them and say, “They're all yours!”

If they ask me for information, I make it a point to provide the information… to someone else, preferably while still in their presence.

We used to have a nurse who wanted to know everything from the patient's favorite color to their Zodiac sign when you called in a pre-arrival report – anything but relevant information. So, when I recognized her voice on the phone, I'd say, “Howdy, Gail! Five minutes out with a bad one!” or when she'd ask why we were bringing the patient to their particular hospital, I'd reply with “Because the zoo is closed and there's nothing good playing at the movies.”

It took about a week for the ER director to buttonhole me and ask why I did that, so I told him.

Gail is forbidden to answer the ambulance phone now.

]]> By: Rob http://lifeunderthelights.com/2009/11/patient-handoffs-from-ems-to-the-er-a-fictional-case-study-not-a-rant/comment-page-1/#comment-812 Rob Tue, 03 Nov 2009 16:33:12 +0000 http://lifeunderthelights.com/?p=457#comment-812 As a first responder with a volunteer group, we are told in our training that the Paramedics will probably do to us what you are describing is done to them. While it's not polite to talk over you, re-asking the questions is important. Why? Well as Dr. House on TV likes to say, "Patients Lie". Someone might not bother to tell us or even the Paramedic about the little blue pills they are popping like candy, but they may change their mind as they get to the hospital. In addition, comparing the answers can give an idea of LOA and changes in condition. Lastly, people make mistakes an since the paramedic who shows up doesn't know me from Jack, I understand that he wants to cover his own ass and re-assess from the start and ignore all my work. Because of this we are told to keep our report to the paramedic as short and sweet as possible. Just the facts ma'am, just the facts. As a first responder with a volunteer group, we are told in our training that the Paramedics will probably do to us what you are describing is done to them. While it's not polite to talk over you, re-asking the questions is important. Why? Well as Dr. House on TV likes to say, “Patients Lie”. Someone might not bother to tell us or even the Paramedic about the little blue pills they are popping like candy, but they may change their mind as they get to the hospital. In addition, comparing the answers can give an idea of LOA and changes in condition. Lastly, people make mistakes an since the paramedic who shows up doesn't know me from Jack, I understand that he wants to cover his own ass and re-assess from the start and ignore all my work. Because of this we are told to keep our report to the paramedic as short and sweet as possible. Just the facts ma'am, just the facts.

]]> By: Ambulance_Driver http://lifeunderthelights.com/2009/11/patient-handoffs-from-ems-to-the-er-a-fictional-case-study-not-a-rant/comment-page-1/#comment-420 Ambulance_Driver Tue, 03 Nov 2009 15:53:31 +0000 http://lifeunderthelights.com/?p=457#comment-420 I have a saying that I'm fond of: "History never repeats itself."<br><br>I've seen answers change too many times to be offended when an ER nurse or doctor asks the patient the same questions I've just given them the answer to.<br><br>OTOH, the fictional nurse in your fictional case was obviously being a condescending bitch.<br><br>In such fictional cases, I have been known to, hypothetically, give the fictional nurse ZERO information thereafter. I'll hand off the patient, smile ever-so-sweetly at them and say, "They're all yours!"<br><br>If they ask me for information, I make it a point to provide the information... to someone else, preferably while still in their presence. <br><br>We used to have a nurse who wanted to know everything from the patient's favorite color to their Zodiac sign when you called in a pre-arrival report - anything but relevant information. So, when I recognized her voice on the phone, I'd say, "Howdy, Gail! Five minutes out with a bad one!" or when she'd ask why we were bringing the patient to their particular hospital, I'd reply with "Because the zoo is closed and there's nothing good playing at the movies."<br><br>It took about a week for the ER director to buttonhole me and ask why I did that, so I told him. <br><br>Gail is forbidden to answer the ambulance phone now. I have a saying that I'm fond of: “History never repeats itself.”

I've seen answers change too many times to be offended when an ER nurse or doctor asks the patient the same questions I've just given them the answer to.

OTOH, the fictional nurse in your fictional case was obviously being a condescending bitch.

In such fictional cases, I have been known to, hypothetically, give the fictional nurse ZERO information thereafter. I'll hand off the patient, smile ever-so-sweetly at them and say, “They're all yours!”

If they ask me for information, I make it a point to provide the information… to someone else, preferably while still in their presence.

We used to have a nurse who wanted to know everything from the patient's favorite color to their Zodiac sign when you called in a pre-arrival report – anything but relevant information. So, when I recognized her voice on the phone, I'd say, “Howdy, Gail! Five minutes out with a bad one!” or when she'd ask why we were bringing the patient to their particular hospital, I'd reply with “Because the zoo is closed and there's nothing good playing at the movies.”

It took about a week for the ER director to buttonhole me and ask why I did that, so I told him.

Gail is forbidden to answer the ambulance phone now.

]]> By: Rob http://lifeunderthelights.com/2009/11/patient-handoffs-from-ems-to-the-er-a-fictional-case-study-not-a-rant/comment-page-1/#comment-419 Rob Tue, 03 Nov 2009 15:33:12 +0000 http://lifeunderthelights.com/?p=457#comment-419 As a first responder with a volunteer group, we are told in our training that the Paramedics will probably do to us what you are describing is done to them. While it's not polite to talk over you, re-asking the questions is important. Why? Well as Dr. House on TV likes to say, "Patients Lie". Someone might not bother to tell us or even the Paramedic about the little blue pills they are popping like candy, but they may change their mind as they get to the hospital. In addition, comparing the answers can give an idea of LOA and changes in condition. Lastly, people make mistakes an since the paramedic who shows up doesn't know me from Jack, I understand that he wants to cover his own ass and re-assess from the start and ignore all my work. Because of this we are told to keep our report to the paramedic as short and sweet as possible. Just the facts ma'am, just the facts. As a first responder with a volunteer group, we are told in our training that the Paramedics will probably do to us what you are describing is done to them. While it's not polite to talk over you, re-asking the questions is important. Why? Well as Dr. House on TV likes to say, “Patients Lie”. Someone might not bother to tell us or even the Paramedic about the little blue pills they are popping like candy, but they may change their mind as they get to the hospital. In addition, comparing the answers can give an idea of LOA and changes in condition. Lastly, people make mistakes an since the paramedic who shows up doesn't know me from Jack, I understand that he wants to cover his own ass and re-assess from the start and ignore all my work. Because of this we are told to keep our report to the paramedic as short and sweet as possible. Just the facts ma'am, just the facts.

]]> By: mmorsepfd http://lifeunderthelights.com/2009/11/patient-handoffs-from-ems-to-the-er-a-fictional-case-study-not-a-rant/comment-page-1/#comment-418 mmorsepfd Tue, 03 Nov 2009 14:36:40 +0000 http://lifeunderthelights.com/?p=457#comment-418 A big problem here is from within our ranks. Inconsistancies are rampant. You, or I or Mark would present the patient at the ER proffessionally and hand things over, but others would give an incomplete report, or worse, a wrong one. <br><br>I try to put myself in the ER staff shoes when these things happen, and they happen a lot. The previous EMS crew could be terrible, and a lot is riding on what we say. All we can do is continue to do our best and not take it personally. A big problem here is from within our ranks. Inconsistancies are rampant. You, or I or Mark would present the patient at the ER proffessionally and hand things over, but others would give an incomplete report, or worse, a wrong one.

I try to put myself in the ER staff shoes when these things happen, and they happen a lot. The previous EMS crew could be terrible, and a lot is riding on what we say. All we can do is continue to do our best and not take it personally.

]]> By: Medic999 http://lifeunderthelights.com/2009/11/patient-handoffs-from-ems-to-the-er-a-fictional-case-study-not-a-rant/comment-page-1/#comment-417 Medic999 Mon, 02 Nov 2009 23:56:20 +0000 http://lifeunderthelights.com/?p=457#comment-417 I feel your pain Chris!<br>Im sure that we all have experienced this, without exception, and one time or another. I certainly have on more than one occassion, but i dont think i was as diplomatic as you were.<br><br>Possible solutions - Get the ER/A&E nurses out on ride-alongs at least every 6 months. Only then can they appreciate the unique differences that we have in delivering care in a non clinical environment.<br><br>And then there is the other alternative - Rotate Paramedics through the ER as part of their rostered duties. Radical but not unheard of!<br><br>I have just got my nursing registration back again, and will be working some bank shifts in the A&E department soon. It should be a real eye opener, which I am looking forward to experiencing and sharing.....Hypothetically of course ;-) I feel your pain Chris!
Im sure that we all have experienced this, without exception, and one time or another. I certainly have on more than one occassion, but i dont think i was as diplomatic as you were.

Possible solutions – Get the ER/A&E nurses out on ride-alongs at least every 6 months. Only then can they appreciate the unique differences that we have in delivering care in a non clinical environment.

And then there is the other alternative – Rotate Paramedics through the ER as part of their rostered duties. Radical but not unheard of!

I have just got my nursing registration back again, and will be working some bank shifts in the A&E department soon. It should be a real eye opener, which I am looking forward to experiencing and sharing…..Hypothetically of course ;-)

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