Giving reports to RNs . . . Why?

[O 2]

Recently I've been wondering why we give our verbal transfer of care reports to RNs & not MDs.

We do a comprehensive rule in/rule out assessment process, manage & treat complaints. Differential diagnosis, field diagnosis, assesment --- whatever you like to call it --- it is essentially a watered down version of what the MDs are doing with the objective of identifying the ailment & treating it.

So in a world where we had plenty of ER Docs running around wouldn't it make much more sense to give that report directly to the Docs then the RN? Doesn't so much get lost in the telephone game of reports? Granted there are plenty of simple sick calls for which this isn't necessary and could be bypassed.


P.S. This is not to knock RNs, I have boatloads of respect for the profession & plan on becoming one myself.

 

[TransportJockey]

My thinking is because the RN is going to be the primary healthcare provider in charge of your patient in that ED. The RN will report to the doc after they've done their assessment as well.

If you're bringing in a lvl 1 trauma patient, you actually should be giving report to the entire trauma team, which has several MDs on it.

 

[CAOX3]

Level ones, reports are to a trauma or medical team. Twos and threes are to a nurse usually. Fours and fives well those are too who ever will listen.

 

[Veneficus]

Recently I've been wondering why we give our verbal transfer of care reports to RNs & not MDs.

There are a few reasons, but the most common I can think of is that nursing is usually responsible for the dynamics (how many?, where?, doing what?, etc.) of the department while the physician concentrates on the patients as individuals.

We do a comprehensive rule in/rule out assessment process, manage & treat complaints..

It is far from a comprehensive assessment.

You treat and manage complaints you are equipped to deal with under standing or online orders. Most if not all ALS units cannot treat all the types of emergency patients.

Differential diagnosis, field diagnosis, assesment --- whatever you like to call it --- it is essentially a watered down version of what the MDs are doing with the objective of identifying the ailment & treating it.

I don't have any issue with the terms, however, the MD (or DO interchangeable and equal in all respects) education can elicit far more findings even without hospital toys than a majority of paramedics can.

treatment options are also considerably more as well. Not many US medics can use the treatments they have available and send somebody home. GPs do it everyday.

Many docs I know simply don't want to hear anyone's findings on a patient until after they have seen them. It helps reduce bias. In the case of a trauma team, the most important info is usually the scene info that cannot be assessed at the hospital.

So in a world where we had plenty of ER Docs running around wouldn't it make much more sense to give that report directly to the Docs then the RN?.

No.

There are not plenty of docs running around. Every patient requires work that perhaps you do not see. A physician is a valuable commodity and interacting with EMS is not always the best use of the physician resource.

Doesn't so much get lost in the telephone game of reports? Granted there are plenty of simple sick calls for which this isn't necessary and could be bypassed.

Many more critical patients come throgh the front door of EDs than by EMS. The ED has a system to deal with handling their responsibilities. When EMS has an appropriate patient, with appropriate findings, the physician in my experience is usually there to meet EMS when it is truly required. Like in the case of a STEMI pt, Life threatening trauma, respiratory arrest, etc.

P.S. This is not to knock RNs, I have boatloads of respect for the profession & plan on becoming one myself.

You just have to consider the total system, not just the part you interact with.

 

[abckidsmom]

In a perfect world, the RN is on the ball, reads between the lines, and advocates for each and every patient as well. As a nurse, I prefer to be the one who hears the story straight from the horse's mouth, if you will. I'm the one who's worked to develop a relationship with the physicians, and they will often listen to the nurse's gut instinct way before they'll listen to a random medic's gut instinct.

Now, burned-out, overworked nurses? Hardly worth relaying more than a couple of sentences to them. They just don't have the capacity to hear any more words in their day.

 

[JPINFV]

For starters, the RN may only be managing 3-4 patients while the physician is juggling several more. As such, the RN is going to be more accessible, unless you don't mind waiting a bit longer to give report.

Many docs I know simply don't want to hear anyone's findings on a patient until after they have seen them. It helps reduce bias. In the case of a trauma team, the most important info is usually the scene info that cannot be assessed at the hospital.

I've definitely seen this. For patients coming from a nursing facility, the RN normally is looking for a watered down version of the chart while the physicians are normally just looking for a C/C and age. On a side note, I'd say that I've met far less grumpy physicians than grumpy nurses.

 

[emtchick171]

If we bring in a "trauma PT" and they are placed in the trauma beds (1-4) at our local hospital...there is a MD waiting on our arrival and waiting on our verbal report.

However, if our PT goes to critical care, triage, FastTrac or the not so serious side of the ER...we give our report to the RN. Simply because there are way more RNs in our emergency room than there are MDs.

The RNs have more time to thoroughly listen, plus they only have 3-4 PTs each. While the MDs are always busy running around taking care of gosh knows how many PTs...

 

[Akulahawk]

Frankly, I don't care WHO gets report, as long as the report is given to someone that can accept the patient from me and is the appropriate person to get the ball rolling for what that patient needs. That can be the Trauma Team (or any other specialized team) or "just" an RN.

But I truly do NOT give a rat's behind about who gets report as long as they're someone that I can transfer the patient to.

 

[46Young]

In my experience, if the pt's not really sick, the doc only wants a quick synopsis, such as "broken arm," "flu like symptoms," or "abd pain for a week." If the pt is serious, they may want to know more. The reason you're speaking to the RN first is that they're recording all the pertinent information, getting thm in the system, and giving that to the doc. Unless they're in bad shape, the doc's not going to be in the room for several minutes or more. Maybe the doctors have witnessed a number of piecemeal, disorganized reports by EMS and don't hold us in high regard. Watch the nurse. They'll typically ask the pt everythinh that you've already told them. The doctor will be working off of their assessment, not yours. The doc and the hospital know who they hired, and can speak for their proficiency. They don't know you from a hole in the wall.

Edit: how many have you worked with that you would never, ever, under any circumstances, work on you or your family? Would you trust their assessment, treatment, and presentastion to the doctor?

 

[Aidey]

For me it depends on the hospital and the doctor. There are some docs who are totally hands off and never talk to us directly. There are others that will beat the nurse into the room, or come in with the nurse to get report, and they want full report. The sicker the patient is the more likely a doc will be in the room, however I've had docs come in on everything.