The Butler Did It

There are any number of different ways to give a verbal handover report at the ED. All sorts of mnemonics. What form you use may depend on what your hospital expects. I try to tell a story. But I don’t tell a story in the same way I would write one. A written story takes you from point A to point Z with all the twists and turns, ending with the Da Dumm! The Butler Did it.

The other day I was listening to a new paramedic tell a triage nurse a great story of a very interesting call. Lots of the above mentioned twists and turns. It started with “We were called for…” It could just as well have started with “It was a dark and stormy night…” The problem was even though it was a great story the triage nurse was getting very impatient, not to mention she was interrupted by other nurses, doctors and her phone during the course of the medic’s novella.

My suggestion to the paramedic was when giving an EMS report to a triage nurse, you have to start with the last line. Begin with “The butler did it,” and then you can explain why you think so. If you are uncertain, you can say, “Either the Butler did it or Miss Scarlet did it.”

Here are some great opening lines:

Hip fracture. Asthma. Seizure. Epistaxis. Hypoglycemia. ETOH. You can fill in the blanks from there.

The bottom line is the nurse needs the bottom line first.


  • Levi Peterkin says:

    Good day,
    I have trouble making a patient report to a triage nurse. Sometimes I don’t know how to remember all the important stuff and summarize it effectively.

  • Travis Jordan says:

    Try CHAMPS (in a more logical order than SAMPLE)
    C – Chief Complaint
    H – History
    A – Allergies
    M – Medicines
    P – Previous Activity
    S – Signs/Symptoms (vitals)

  • SueEdRn says:

    Gooooodness do I want to print this out and leave it in the EMS room.
    What do you think the accuracy is of what you were called for and what the actual complaint was?
    It is a pet peeve of mine when report is started that way because it almost never relates back to the patient’s actual complaint.
    Pet peeve #2 is when I hear someone say “O2 stat”
    Biggest is when the term literally is used when they should be saying figuratively but i digress…

  • Bob Sullivan says:

    I like that approach. I teach my students to work on giving reports in 10 seconds or less, because that is probably about how long someone will pay attention before they start doing something else. It also helps them think about what information is most important.

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