Wednesday, April 10, 2013

it ain't rocket science

Good luck to hospitals in the almighty patient satisfaction sweepstakes. They are approaching it all wrong.  They are approaching it from the top down, instead of the bottom up.

I am currently on a committee addressing this.  I sat for an hour and a half at the last meeting listening to a "performance improvement specialist" talk about what we say to patients.  What do we say to them when they present at the window?  Do we say: Can I help you? What can I help you with? How do we acknowledge them?  I mean seriously....

It seems the triage area is a place where people don't "feel welcome".  Could that be because the staff appears stressed out? THEY ARE STRESSED OUT.  Here is a list of what the two nurses at the triage desk deal with:

1) Answer phones:
     - from ambulances coming in, place those ambulances in the ER (if there is a bed available)
     -from idiot doctors offices, nursing homes, therapists, etc. who call to tell us their patients are coming in.
WE DON'T CARE.  We will deal with them when they get here.
     -calls from information desk about patients they can't find
     -random other calls

2) Let people in the door to main ER a thousand times a day. Deal with frantic relatives.

3) Give directions to people to inpatient rooms,  the cafeteria, coffee shop, pop machine, admitting, etc. etc. etc.

4)  Deal with people who have to be transferred to labor and delivery.

5)  Go outside to help people out of cars.

6)  Check people in.

7) Triage people.  WOW, yes we actually have to do this in the middle of everything else.

8) Take people to rooms.

All of this is really great, especially when there are 10 people at the window, 20 people in the lobby.

In the middle of all this we are expected to smile like a frickin' idiot.  Let me ask you, could you smile like a frickin' idiot in the middle of all this?  I don't think so.

Here is what will help patient satisfaction in triage:


No doctor office, etc. calls

Security handles traffic in and out.

Charge nurse gets ambulance calls.

Come up with the money to have someone at the desk which allows nurses to actually TRIAGE (what a concept).

If you take some of the  stressors in triage away, staff will be happier, less stressed and they will be able to welcome patients as they should.  Patient satisfaction improves. This ain't rocket science folks.

Here's a clue: Maybe you could ask the staff who works in triage what they see could help the situation.  What a radical idea.


jimbo26 said...

Sorry , but you are using common sense there , and putting ' consultants ' out of a highly paid job . ;-)

Aesop said...

Ask those who do the job what it needs?

That right there is crazy talk.

Next you'll be telling us that the best way to manage expectations would be to base how well we're doing on carefully documented pertinent metrics related to actual medical criteria like accuracy of diagnosis, lack of medication errors, and speed of addressing documented medical problems, instead of relying on people whose average education level is a GED and whose average intelligence is somewhat below the mean, given where they are and how they landed there a good bit of the time, to tell a bunch of people vastly more qualified and far better prepared that they're doing it wrong, because it doesn't "feel" magical.

When the corporate jackholes who get paid three times my salary to pump this happy gas come at it from the perspective of ride operators at Disney World, it only argues for kicking their Goofy @$$#$ into triage, chaining them to the desk for 48 hours non-stop on a holiday weekend, and telling them to get back to us with their thoughts, because the post-brief will be conducted by them, to a room full of professionals, right after their 48th hour - while everything's still fresh in their mind.

The best use of consultants is to cheerfully run them over in the parking lot, then let trainee orthopods practice splinting them, absent anesthesia or pain control, then feed them to wild pigs. But I've gotten rather soft in my advancing years.

Anonymous said...

Since you're on the committee you have a great opportunity to say this to the consultant.

You're right, they have absolutely no idea what stressors you're up against and they never will unless you tell them. Invite them to come spend a Saturday nightshift sitting in triage :)

Anonymous said...

Our ER has our EMS radio at the main nurses desk so anyone around can answer which helps a lot. No one is allowed t ocome to our triage window we make them go to the next window that registers them which is a huge huge help. Anyone that comes to our window we just point to the sign that says next window please. They made every staff member in our system go to a patient satisfaction class where they told us it is not good enough to give directions to the cafeteria. Instead they want us to walk them there, engaging in a whole life convo,e then introduce them to the cafeteria worker and explain what they need help with...who has time for that?