Monday, 8 August 2016

It’s all about the Encounter……, but what about Metrics?

There have been waves of changes which are happening across the world of emergency care. Different nations approach emergency medical services differently.

The one thing that continues to remain common is the patients their pathologies and the metrics which govern the operations of emergency departments.

In accountable cultures the patient experience is a key feature of the emergency department visit. Physician salaries and insurance payment for clinical care are tightly tied to the satisfaction level of the patient once the care provided has been availed. It is more like an evaluation you give after you avail a Telephone customer service. There is also a lot discussion which suggests that Good Patient Experience in the Emergency Department leads to lesser complaints and lesser legal problems.

On the other hand we have the massive pressure of metrics. There are different metrics in different cultures and different nations. It’s all about the financial logistics which drive sustainability.
So the demands on the Emergency Physician are tremendous.

Let’s look at the parameters of this perspective:

Emergency Departments are getting overcrowded:
That is good for the specialty but also a reflection of the strength of primary care available. Hence when patients seek Emergency Care for primary Care pathologies….there is a strain on the system. Seeing patients fast, screening the life threatening pathologies out from the waiting room and maintaining pleasant patient experiences becomes challenged.

Emergency Department Metrics:
Metrics and Measures drive the working of a Modern Emergency Department. How many patients are seen per hour per physician, how many CT Scans are ordered, How many tests are ordered, how soon were antibiotics, aspirin and life saving measures instituted etc. These are benchmarks and may like these to which an Emergency Physician has to strictly adhere too or there may be no employment…

 Patient Experiences:
With the existence of above pressures which include seeing patients fast, evaluating them and treating them safely, and maintaining the numbers for meeting core measures and metrics the Emergency Physician is responsible for making the patient experience a satisfying encounter.
There is a lot of thrust on the above Marker. I am well aware that hospitals and health system are hiring 5 Star Hotel Hospitality Gurus to create Hospitality Training Models for health care workers.

How does one welcome the patient, how does one behave with the patient as soon as the patient car hits the gate of the hospital, till the time the patient goes home.

It’s all about Communication Skills….. That’s what it comes down too.

But what about Emergency Life threatening Conditions, Critical Life Saving decisions Scenarios, a critical environment where things change within seconds…..

Emergency Departments and Emergency Patients are different from Primary Care Patients and Clinic practices.

I firmly support that compassion is key to patient care and it’s all about communication skills BUT different things are done differently in different situations.

It’s good to be inspired from the airline industry to design a Safety checklist for healthcare and it is good to be inspired by the hospitality industry to introduce customer satisfying protocols….but in Emergency Health Care…. We have real patients…. Not Air Travelers and definitely not the crowd which visits resorts and beach hotels.

The psychological mindset is totally different on either sides… patients and providers.

We have to work on Safety norms which consider the culture of Acute Decision Sciences at the same time the Communication algorithms have to be modified into a systems approach.

Physicians have to be kind to their patients and communicate with them and also meet the metrics.

Greeting patients, updating them about the plan and also appraising them of the test results and the future course of action is key. Closing the encounter by telling the patient what you are going to do …discharge or admission and details of the process are key.

If you haven’t been able to appraise them then apologizing and then appraising them is of help…. But again this if put into a process will definitely change the way we deal with our patients.

The process needs to play a role because metrics and overcrowding are key factors and just assuming that Patient Experience is directly equal to Physician Communication Skills is not completely correct.
The whole culture of communication has to start from the time patient arrives in the ED. If the patient expresses the slightest concerns then the team member has to activate the physician of the concern and that should be addressed and documented.

Documentation is key and Communication is also visible via the documentation in the chart.
There will be patients who are tough to deal with … but again it’s all about the skills and not getting emotionally hijacked is the key.

All this needed intense training and an ongoing commitment to improve oneself. Taking the feedback on patient complaints positively and the advice of your colleagues and nurses positively is very important for personal growth as a human being.

Treat you patients like you would like to be treated……. My Teacher taught me that and I continue to practice the same !


  From the Desk of                                                                                                                                                                                         Sagar Galwankar, MBBS, DNB, FACEE (India), MPH, Dip. ABEM (USA), FRCP (UK)

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