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When we pick up patients from the ED without any chart or physician orders, isn't that unsafe and a liability for the nurse?

Wednesday September 5, 2012
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Dear Nancy,

I am an RN and work in an acute care hospital on a med/surg oncology unit. When we are paged to go to the ED to pick up our assigned patient, there are times when we arrive and the patient's physician has the chart and still is writing orders. The ED charge nurse and supervisor tell us to take the patient up to our unit without the orders or the patient's chart — they say they will bring them up later when the physician is done and that it could be awhile. My concern is, what if something happens to the patient on the way or after he or she is in the unit and we have no chart or orders? This seems unsafe for the patient and a liability for the nurse. What do you think?


Nancy Brent replies:

Dear Liza,

Your concerns about transferring the patient from the ED to a unit in the facility are well founded. In fact, the Emergency Nurses Association published a position statement about this very issue, initially in 2002, but revised and adopted by the ENA board of directors in 2010.

You can read the entire statement on the website (www.ena.org), under the About ENA tab, click on Position Statements.

Briefly, the statement, covering intrafacility transfers of a critically ill patient from the ED, states that such a patient requires the same "high level of knowledge, skills, clinical judgment and technological expertise of the emergency nurse ...available in the ED [and it] should be continued during the intrafacility transfer." Moreover, the statement continues, the intrafacility transfer of the ED patient should not result in a compromise of the patient's condition. Assignment of those who will transport the patient, should be based on many factors, including patient acuity and the skill level and clinical judgment of the individuals providing care during the transfer.

It sounds as though the practice you describe in your facility does not coincide with this position statement. It might be wise for you to discuss this with your CNO and the ED director of nursing, so that a reasonable solution can be reached that does not compromise the patient's condition. For example, perhaps the ED nurse can (and should) at least provide as complete a "hand off" report that is possible at the time. Or, as suggested by the ENA, the ED could alter its staffing patterns to allow an ED nurse and appropriate ancillary staff to support and accompany the patient during the intrafacility transfer.


Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.