Medical-Surgical Nursing · Emergency Care

Transferring from the Emergency Department

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On this page 9 sections

In 30 seconds
Why this matters
The college version
Eli explains
Worked example
Key takeaway
Check yourself
Study tools
Sources & references

In 30 seconds

The emergency department (ED) is built to stabilize, not to house. Once a patient's immediate needs are addressed, the person moves on to another care setting: an inpatient unit, an observation unit, a different facility (such as a trauma or burn center), or home. That move — and everything nurses must do to make it safe — is the transfer from the emergency department.

A transfer is easy to underestimate because it looks like a simple physical move: a bed rolls down a hallway. In nursing terms, however, a transfer is a . The ED nurse is responsible for the patient until the receiving nurse accepts that responsibility, which happens only when the essential information has been communicated, the receiving nurse has verified the patient's status, and any outstanding items (pending test results, follow-up instructions) have a clear plan. The information passed between nurses is called a handoff or handover, and its quality is one of the strongest predictors of whether the patient experiences a safe transition or a preventable error.

Why this matters

Handoff failures are a well-documented source of harm across health care. When the ED nurse forgets to mention an allergy, a pending laboratory result, or the time of the last pain medication, the receiving nurse may make decisions on incomplete information — or the result may never get followed up at all. Accrediting bodies treat handoff communication as a core patient-safety standard, and most facilities require a structured, verifiable report before a transfer is complete.

For med-surgical nurses, this topic is personal: the med-surg unit is where most ED patients land. The admitting nurse inherits every omission. Understanding what a complete transfer looks like — and what the receiving nurse must verify independently — is both an exam concept and a daily safety skill.

The college version

Core Concepts

Types of transfers from the ED

Admission to an inpatient unit — the most common transfer for med-surg nurses. The patient moves from ED to a unit (medical, surgical, telemetry, ICU, or an observation area) with new admission orders.
Transfer to another facility — used when the patient needs a higher level of care the current hospital cannot provide (e.g., a burn center, a specialty children's hospital, or a center for hyperbaric care). This requires arrangement with the receiving facility, transport (often by ambulance or air medical team), and copies of records and imaging.
Discharge home — technically also a transfer of accountability, from the ED nurse to the patient and family. Discharge teaching, prescriptions, and follow-up arrangements must be as deliberate as any inpatient handoff.

Each type has different paperwork and communication requirements, but the underlying duty is the same: the patient's story must travel with the patient.

The handoff: transferring accountability

A handoff is more than "giving report." It is the transfer of responsibility and authority for the patient's care. Most facilities standardize the content with a mnemonic such as — Situation, Background, Assessment, Recommendation — or I-PASS, a more detailed format used in many hospitals. Whatever the tool, a complete report typically covers:

Identifying information, chief complaint, and relevant history
Current assessment findings and vital sign trends
Interventions already done (medications given, procedures performed, tests drawn)
Pending items: labs, imaging, consultations that have not yet returned
Code status, allergies, isolation precautions, fall risk, and other safety flags
Family involvement and communication needs (language, literacy, cognition)

closes the loop: the receiving nurse repeats back the critical items, asks clarifying questions, and confirms readiness to accept the patient. The report is not complete until that confirmation happens.

The receiving nurse's admission role

Accepting report does not end the receiving nurse's work — it begins it. The admitting nurse must:

Perform their own and verify the patient's condition at the bedside (report describes the patient; it does not replace seeing the patient)
Review and verify admission orders with the provider
Reconcile medications: compare what the patient was taking before, what was given in the ED, and what is newly ordered
Orient the patient and family to the room, call system, and plan of care
Flag anything that does not match the report

This independent verification is a professional and legal safeguard: accountability was accepted, but accuracy is confirmed by assessment.

Pending results and follow-up

The most dangerous gap in a transfer is the pending result. A laboratory value or imaging study ordered in the ED may return hours after the patient reaches the unit, when the ED nurse is caring for someone else. The handoff must name every pending item, who is responsible for tracking it, and what to do if it is critical. Many facilities have policies that critical results are called to the nurse caring for the patient at the time the result returns — which is why the handoff must make that nurse aware that a result is coming.

Barriers to safe transfer

ED crowding and "boarding" (holding admitted patients in the ED because no inpatient bed is available) strain handoffs. Interruptions, missing documentation, language barriers, and patients who cannot speak for themselves (due to sedation, cognitive impairment, or intubation) all raise the risk of information loss. Strategies include structured checklists, designating a quiet space or time for report, involving the patient and family as sources of information, and using interpreters rather than relying on gestures or relatives.

Common Confusions

Do Not Confuse	With	Difference
Transfer	Discharge	A transfer moves the patient to another care setting with continuing nursing accountability; discharge ends the facility's responsibility and shifts it to the patient/family with teaching
"I gave report"	"Accountability has transferred"	Report is only complete when the receiving nurse accepts it — verbally confirmed and in person per policy
SBAR	SOAP	SBAR is a communication/handoff tool; SOAP (Subjective, Objective, Assessment, Plan) is a documentation format for progress notes
Admission status	Observation status	Admission means the patient is formally admitted to the hospital; observation is a shorter monitoring status with different rules — the nurse should know which applies to the patient
Telling the receiving nurse	Teaching the patient	The handoff informs the nurse; the patient/family still need their own orientation, education, and discharge teaching — both are required

Eli explains

The same idea, in plain words

Explain it like I’m 10

When someone leaves the emergency room to go to a regular hospital room, the nurses pass important health information from one to the other, like runners passing a baton in a relay race. If the first runner drops the baton — forgetting to say a medicine was given or a test is still waiting — the next runner can't do the job properly. A good transfer means the whole story travels with the patient, and the new nurse double-checks it before taking over.

Worked example

Mr. Chen, 68, arrives in the ED with new-onset slurred speech and right-arm weakness. The ED team stabilizes him and the provider admits him to the med-surg unit with a suspected transient ischemic attack workup. Before transport, the ED nurse, Priya, calls the med-surg nurse, Dana, and gives an SBAR report: situation (possible TIA, admitted for stroke workup), background (history of hypertension and type 2 diabetes, last known well time noted in the chart), assessment (neuro checks stable, blood glucose checked, aspirin given per order), and recommendation (follow pending MRI, keep NPO until swallowing evaluation, bedrest with fall precautions). Priya mentions that the MRI is still pending, the patient speaks Mandarin and needs an interpreter, and the family is waiting in the lobby. Dana repeats back the critical items — NPO, fall precautions, pending MRI, interpreter — and confirms she will accept the patient.

When Mr. Chen arrives, Dana does her own assessment. She notices his speech is slightly more slurred than the report suggested and that he is trying to get out of bed. She re-checks his neuro status, documents the change, notifies the provider, and requests a sitter while the fall-risk interventions are implemented. Because the handoff included the pending MRI and interpreter needs, Dana knows to check for the result, involve the interpreter in all teaching, and escalate the neuro change immediately.

Now imagine the alternative: Priya had rushed the report, skipped the pending MRI and the interpreter note, and Dana assumed the patient was a routine admission. Mr. Chen's neuro change might have been dismissed as "the same as in the ED," the MRI result might have sat in the queue unnoticed, and the family might have received teaching they could not understand. The difference between these two outcomes is not skill — it is the completeness of the transfer.

Key takeaways

A transfer is a transfer of accountability, not just a change of location; the ED nurse remains responsible until the receiving nurse accepts report per policy.
Use a structured handoff tool (SBAR, I-PASS, or the facility's format) so nothing important is skipped.
Always communicate pending results — who is tracking them and what to do if they are critical.
The receiving nurse must perform an independent admission assessment; report is not a substitute for seeing the patient.
Reconcile medications at every transition — home meds, ED meds, and new orders must match.
Include safety flags: allergies, code status, isolation precautions, fall risk, and communication needs.
Involve the patient and family; check for language, literacy, and cognitive barriers.
Scope-of-practice and handoff procedures vary by state and institution — follow facility policy.

Check yourself

5 review questions from the chapter. Try each one, then open the answer.

What is the difference between a physical transfer and a transfer of accountability?
Show answer
The physical transfer moves the patient's body; the transfer of accountability moves responsibility and authority for care. The ED nurse remains accountable until the receiving nurse accepts the report per facility policy.
List four elements that must be included in a complete ED-to-unit handoff.
Show answer
Any four: identifying info and chief complaint; history and current assessment; interventions already done; pending results; code status/allergies/precautions/fall risk; family and communication needs.
Why must the receiving nurse perform their own admission assessment instead of relying only on report?
Show answer
Report describes the patient at the time it was given; the receiving nurse must verify the patient's actual condition, confirm orders, and establish a baseline. Patients can change — sometimes rapidly — between report and arrival.
What is the danger of a pending laboratory result at the time of transfer, and how is it managed?
Show answer
The result may return after the ED nurse is no longer responsible for the patient; if it is abnormal and no one is tracking it, it can be missed. Management: name every pending item in the handoff, identify who tracks it, and follow facility policy for critical results.
Who remains accountable for the patient if the receiving nurse has not yet accepted the report?
Show answer
The ED (transferring) nurse remains accountable until the receiving nurse accepts the report. This is why facilities require confirmed, documented handoffs before the patient is moved.

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Study tools & related lessonsKey vocabulary · Related

Key vocabulary

Handoff / handover: The structured transfer of patient information and accountability between caregivers
Transfer of accountability: The moment responsibility for the patient passes from one nurse to another
SBAR: A communication format: Situation, Background, Assessment, Recommendation
Closed-loop communication: The receiver repeats back key information and confirms understanding
Medication reconciliation: Comparing all of a patient's medications at a transition to catch errors and omissions
Pending results: Laboratory or imaging studies ordered but not yet returned at the time of transfer
Observation status: A hospital status for patients needing monitoring or short-term care, distinct from full admission
Admission assessment: The receiving nurse's own head-to-toe evaluation on arrival to the unit

Sources & references

openstax.org — Medical Surgical Nursing

This lesson was adapted from the open educational references above; their licenses and attributions are preserved. See Copyright & Licensing.

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