Be proactive about improving communications
Be proactive about improving communications
Given the findings of a recent study in the Annals of Emergency Medicine,1 ED managers should take immediate steps to improve communications with patients, says Bruce Janiak, MD, FACEP, FAAP, professor of emergency medicine, Medical College of Georgia, and vice chair of the ED at MCG Health Medical Center, both in Augusta.
"The manager should call a leadership meeting, and it should be the first item on the agenda," he says. In that meeting, says Janiak, the manager should note that "it has been alleged patients are not paying attention to our instructions." Those who agree that this is a problem should then be asked to participate in a project to simplify discharge instructions. "Normally, a hospital has a forms committee you need to go through to revise forms, but after the ED leadership meeting, the ED manager should show up at their next meeting and tell them this is what the department wants to do and how it wants to do it," he advises.
Kirsten Engel, MD, a clinical instructor in the Department of Emergency Medicine at Northwestern University's Feinberg School of Medicine and an ED physician at Northwestern Memorial Hospital, both in Chicago, says her ED already has begun to take steps to improve communications. Engel is lead author of the recent study.
"We did some focus groups [with prior patients] and, based on that input, we are trying to make sure that multiple providers — nurses, doctors, and residents — communicate the instructions to the patients," she says. The provider who sees the patient first will prepare the patient with basic information about their condition and then tell them the doctor will be in to answer additional questions.
There also have been subtle, but important changes in the way patients are addressed, says Engel. For example, instead of asking patients if they have any questions, the patient is asked what questions they have. "Our body language is now more engaging," Engel says. "We don't have our hand on the door when we talk with patients, or look on the floor. I find more of us are taking a moment to reflect, to look at the spouse [so that they, too, will better understand the instructions], to think for a moment before speaking."
Reference
- Engel KG, Heisler M, Smith DM, et al. Patient comprehension of emergency department care and instructions: Are patients aware of when they do not understand? Ann Emerg Med 2008; Doi:10.1016/j.annemergmed.2008.05.016.
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