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Vol. 12, No. 6

Care Management

Turn to SBAR for Handoffs to the Emergency Department

Summing up whats going on can expedite care.
You may send a resident with signs of a life-threatening condition to the ED in a blaze of ambulance sirens. But to keep the care ball rolling when he arrives, make sure to pass along vital information to the ED triage nurse by phone. Consider using an SBAR format, which stands for Situation, Background, Assessment, and Recommendations, advises triage expert Carol Rutenberg, RNC-BC, MNSc, principal of Telephone Triage Consulting Inc. in Hot Springs, Ark. She provides an example of an SBAR report below. Situation: Patient states he is too fatigued to get out of bed and is experiencing shortness of breath. This is a change from baseline for this patient. BP 155/90, P 112, R 28; the patient is afebrile but diaphoretic and pale. Breath sounds and heart sounds are unchanged. Patient has a pulse consistent with atrial fibrillation. Urine output is good. Appetite is poor. Background: This patient has a history of congestive heart failure, diabetes, and hyperlipidemia with one MI in the past. He is usually alert and oriented and ambulates with a walker. Assessment: Im concerned that this is a significant change for this patient and I believe his hemodynamic status is potentially compromised. Watch out for wording: If an LPN is making the report, you have to be careful about using the word assessment in a state that doesnt allow the LPN to assess, Rutenberg cautions. In such states, however, the LPN can collect and provide data about the patients condition, such as vital signs, etc. The RN can and should however provide their assessment of whats going on, if only to provide a brief statement like the one above, she advises. Recommendation: In this case, it would be that the patient be seen by the ED staff for evaluation, says Rutenberg. n

Survey Management, continued from cover In addition, Bianculli advises considering an appeal in cases where the remedy (termination or a very high civil monetary penalty) so demands. In his view, other reasons to consider an appeal route include scenarios where the facility wants to do the following: Avoid the Special Focus Facility list or other adverse regulatory actions, including negative [certificate of need] or state consequences, says Bianculli. Position the facility to defend against litigation. Consider an appeal when the facility fears a civil lawsuit and wants to rid the statement of deficiencies of unnecessarily lurid language that could have a negative impact on a jury, henotes. Make a stand when the facility really is right and needs to support its staff, and/or make a point to surveyors. Deal with a recurring issue where the facility needs clarification of the governing standards. 2: Consider doing an IDR as a prelude to an appeal. You can proceed with IDR and also file a request for a hearing so youre good to go with an appeal if IDR doesnt turn out like you want. A lot of people think that if you request a hearing with an ALJ, you have to go through with a hearing, says attorney Neville Bilimoria, with Duane Morris LLP in Chicago. But thats never the case. In fact, Bianculli says he ordinarily recommends facilities consider doing an IDR and appeal together.
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Consider an appeal when the facility fears a civil lawsuit and wants to rid the statement of deficiencies of unnecessarily lurid language that could have a negative impact on a jury, says attorney JosephBianculli.

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