It's easy to write about the importance of effective provider-patient communication and care coordination. How fragmented care causes patients frustration, fear and can lead to readmissions. But it's another matter entirely to attempt to navigate the healthcare system and experience the lack (or at least perceived lack) of care coordination first-hand.
My family's tale began earlier this month when a relative, who falls in one of Medicare's most vulnerable populations, needed emergency surgery. After six hours of tests and consultations in a local hospital emergency room, he was transported by ambulance to a facility further away that had the resources and critical care team better equipped to handle the operation. The ER doctor who first examined him wasn't sure he'd survive the surgery and we all prayed for a positive outcome.
The situation was especially frightening for our loved one, who is mentally challenged, has a limited vocabulary and often uses sign language to communicate. But he couldn't use his hands as they were put in restraints so he wouldn't pull out the tubes to his IV. Although the ER medical team initially resisted, they eventually understood why he needed a familiar caregiver to stay with him constantly to provide him with reassurance.
There were more anxious days as he recovered in the surgical intensive care unit. We did the best we could to stay updated on his condition while we were at work during the day, visiting later in the evenings. But details were scarce; often the nurse taking care of him had just come on duty when we arrived and hadn't yet communicated with the nurse who just ended her shift.
But it was when he was going to be moved to a regular floor that it became more difficult to navigate the system and find out who was actually in charge of his care. In addition to his nurse, there was the surgeon who performed his surgery. And there was the hospitalist on the surgical ICU floor who looked after him. We talked to a medical resident one day. But then he told us a new doctor would oversee his care once he was transferred to the new floor. And then there was the matter of making sure his primary care team was aware of his condition and treatment plan. Somewhere along the way a case manager was involved to help coordinate the care after discharge and make sure his regular caregivers received the necessary information about his follow-up care.
We seemed to get conflicting reports on his condition and discharge plans every day. Although one member of our family is a registered nurse and I write about healthcare, we often felt lost in the system, confused by what seemed to be a lack of communication among clinicians about his care plan.
Fortunately, the story has a happy ending and he is now recovering at home. We are grateful for the care he received during his hospital stay. But some of the angst experienced along the way could have so easily been avoided.
Here is what I've learned:
1. Communicate every step of the way. Beginning in the ER, it would be so helpful to have someone appointed who can provide family members and the patient with updates about what is happening. Even if it's simply to say, "We haven't forgotten you. We are still waiting for the test results to arrive."
Sam Garber, a planning analyst at Carilion Clinic, a not-for profit healthcare organization based in Roanoke, Virginia that includes a network of hospitals, primary and specialty physician practices, tells me this type of constant and positive communication can occur. One of his facilities assigns a patient representative to the emergency department. This person reports directly to the nurse leader and attends hourly rounds with the senior leadership team. The rounds are done in front of patients and their families. The representative checks in with family members in the waiting room, asking if they need anything, like a blanket, food or help contacting their insurance company. That is a true effort to improve the patient experience.
This type of communication is also necessary once the patient is admitted. Doctors and nurses should introduce themselves when they walk in the patient's room, even if they met with the patient the day before. And they should carefully explain what they are doing as they are doing it. If you intend to transfer the patient to a different room or floor, explain why and then inform the patient and family why it's taking so long to occur. While this type of information may not seem necessary to the clinicians who are treating many patients, it is vital that patients are informed so they don't feel forgotten.
2. Practice the teach-back method. Many organizations use the teach-back method during the discharge planning process to make sure patients and family members understand the follow-up care instructions. But I believe this type of conversation should happen every step of the way. So many times during our recent experience, a family member would relay information to us, and later we learned he or she misunderstood what the doctor said or meant.
3. Don't forget the patient is a person, not a case. While clinicians may deal with a particular condition every day, in many cases this is the first time a patient or family member is experiencing the problem. Be patient with the patient and their caregivers. And remember that no matter how little a patient may be able to communicate his needs, he has them. He experiences pain, sadness, fear. Respect it and find a way to communicate with this person, via a family member or an interpreter. Ilene (@FierceHealth)
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