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)