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Med-Surg · chapter 33 · Emergency Care

Transferring from the Emergency Department

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 3 practice questions with the reasoning.

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Key points

  1. Discharge communication role

    With nurses delivering the majority of discharge instructions and educating patients and families, it is imperative that they communicate effectively and provide comprehensive teaching.

  2. Readmission prevention framework

    Following an optimal framework for discharge planning can potentially help reduce hospital readmission rates.

  3. Initial discharge planning

    Discharge planning should begin upon initial assessment, where the nurse utilizes screening tools that apply to the patient.

  4. Ongoing discharge readiness

    Nurses and health-care providers must continuously assess patient discharge readiness, available resources, and follow-up appointments.

  5. Post-discharge follow-up calls

    Post-discharge follow-up calls by the nurse are an integral part of the discharge framework as well (Yam et al., 2012).

  6. Daily transfer strategies

    Strategies should be implemented on a daily basis and across the facility to maximize patient flow.

  7. Stability before transfer

    Under the Emergency Medical Treatment and Labor Act (EMTLA), patients must be stable prior to being transferred to any other unit or health-care facility.

  8. ABCDE triage assessment

    When initializing and stabilizing the patient, nurses should follow the ABCDE triage assessment method.

  9. Pre-transfer order completion

    Prior to transfer, the nurse should confirm that all vital signs are stable, and all provider orders have been implemented.

  10. Outstanding transfer concerns

    When completing patient transfers, the nurse must communicate any outstanding orders or patient care concerns to the nurse taking over the patient’s care.

  11. SBAR handoff standard

    The gold standard for reporting hand-off is using the SBAR method (Dalky et.al., 2020). SBAR stands for Situation, Background, Assessment, and Recommendations.

  12. SBAR communication objectives

    When the SBAR communication handoff tool is implemented, nurses communicate using a standard set of objectives related to the patient’s condition.

  13. Clear discharge education

    Nurses need to ensure discharge information is conveyed in a clear, concise, easily understood format, keeping in mind the patient’s preferred language and educational level.

  14. Discharge readiness documentation

    The nurse will document these steps in the patient’s discharge plan and ensure that they have a clear path forward once they leave the facility.

Terms to know

acuity
The term acuity represents how the health-care team determines the severity of a patient’s status (Managed Healthcare Executive, 2020).
SBAR
SBAR stands for Situation, Background, Assessment, and Recommendations.
Care coordination
Care coordination is a vital component of patient care in any setting but can be especially important (and challenging) in fast-paced acute care settings.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. At 08:15, during an ED patient's initial assessment, you identify limited support and uncertainty about resources at home. Testing is underway, and the disposition has not been decided. What is the best next step for the discharge plan?

    1. Document the concerns and begin care coordination after the initial assessment, updating the plan as care continues.
    2. Document the concerns and wait for a home-discharge decision before beginning care coordination.
    3. Document the concerns for reassessment after testing is complete, then decide whether to begin care coordination.
    4. Document the concerns in the transfer handoff so the next care setting can begin discharge coordination.

    Answer: Document the concerns and begin care coordination after the initial assessment, updating the plan as care continues.

    Care coordination should begin after the initial assessment and continue as an ongoing process. Waiting for a home-discharge decision, completed testing, or the next care setting delays addressing needs that have already been identified.

  2. At 11:00, an ED patient with pneumonia is being transferred to the intensive care unit. You are organizing the written SBAR handoff. Which available information belongs in the Background section? Select all that apply.

    1. Comorbidities relevant to the current situation.
    2. Current assessment findings of bilateral coarse breath sounds.
    3. Recommendations for future testing.
    4. Previous treatments for the same condition.
    5. Past surgeries relevant to the current situation.

    Answer: Comorbidities relevant to the current situation., Previous treatments for the same condition., Past surgeries relevant to the current situation.

    Background supplies history relevant to the current problem, including comorbidities, past surgeries, and treatments for the same condition. Current breath sounds belong in Assessment, while proposed future testing belongs in Recommendations.

  3. At 16:30, a patient who received sedation is preparing to leave the ED with a companion. You are planning the aftercare review and its documentation. Which approach best follows the section?

    1. Review aftercare activities with the companion and document that review in the discharge plan.
    2. Review aftercare activities with the patient and document that a companion is available.
    3. Review follow-up appointment details with the companion and document that the patient received aftercare instructions.
    4. Give printed aftercare instructions to the companion and document receipt of the materials.

    Answer: Review aftercare activities with the companion and document that review in the discharge plan.

    For a patient who received sedation, the section specifically calls for reviewing aftercare activities with a companion. Reviewing only with the patient, recording receipt of printed materials, or discussing only follow-up appointments does not establish that the companion received the required aftercare review.

Where every quote comes from

Section 33.5 Transferring from the Emergency Department of Medical-Surgical Nursing by Christy Bowen, Bridget Carey, Jessica Palozie, Maren Reinholdt, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.