I am the Nursing Supervisor for Cardiac/Thoracic/Vascular surgery in the operating room at SMCA. On the morning of 4/9/14 I received a call from the board runner/charge nurse. She informed me that the ED had called to let us know that Dr. J (CTVS vascular surgeon) had accepted a transfer from SNW ED for an elderly patient with a ruptured abdominal aortic aneurysm (we refer to this as a "triple A". He wanted the patient to come straight to the operating room as soon as the ambulance arrived.

These transfers directly into the OR are complicated and sometimes the communication handoffs are not optimal. Information is passed through several people (ED nurse at SNW to ED nurse at SMCA to OR board runner to surgical team) and sometimes critical items are missed or not communicated in a timely manner. This is further complicated by the fact that when patients come to the OR directly from the ambulance, the ED really isn't involved in the patient's care. To facilitate the transfer I directed the team assigned to the case to start getting the OR ready while the CRNA and I went to the ED to receive the patient and get a firsthand report from the ED charge nurse.

When I arrived to the ED, I asked for the charge nurse, Katherine Esteban. What then ensued was one of the most complete occurrences of communication and planning I have ever been privileged to receive from the ED staff. Katherine had just finished speaking with the ED nurse at SNW. She gave me the patient's name, age, current status, allergies, ETA for the ambulance and the fact that a SNW ED nurse was helping transport and that the patient was receiving two units of uncrossmatched blood in route. I called anesthesia upstairs and confirmed that they wanted 4 units of un-crossmatched blood ready to go to the OR with the patient from our blood bank. Before I could even pick up the phone, Katherine had made arrangements for this to be done. I asked if there was any way the patient could be registered and stickers with the new financial number printed because we didn't have the patient in our system yet and couldn't print stickers until after the patient was registered. Within a couple of minutes, she returned with admission paperwork and a sufficient number of stickers to help us start our case. About the same time, one of the ED CA's arrived and handed me a blood cooler with the un-crossmatched blood.

She further updated me that the family would arrive after the patient because they were traveling by POV. I asked if she could make sure that the family was taken to the ICU waiting area and gave her my phone number and requested that she let me know when the family arrived. She said she would do that. Dr. J arrived to the ED at that time, and he, the CRNA and I were able to greet the ambulance and take the patient immediately to the OR. Katherine let me know when the family arrived and was in the ICU waiting room so I was able to update them immediately.

I went downstairs the following day to thank her for her exceptional handoff of this patient, but she was off. I couldn't remember her name because I was more focused on the patient transfer at the time of the incident, but saw one of the staff who was present for the incident. I asked her name so that I could write this commendation. She was then described to me by several of the ED staff as "an angel", the most positive and helpful nurse in the ED, and just "wonderful" to work with by her peers in the ED. I was not surprised at all based on my encounter with her. Her manager was not in the department at the time I stopped by, but I spoke with him and related the incident and let him know that I was submitting this nomination for the DAISY Award.

I understand that Katherine was recently promoted to a nursing supervisor position in the ED, and this will be very good for the ED staff and our patients who begin their care in our ED. She is exactly the type of nurse that we should all strive to be compassionate, caring, and focused on what needs to be done to meet patient care needs.