Imagine if Your Favorite Restaurant Ran Like An Emergency Department

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Setting Patient Expectations in the ER

Imagine you walk into a restaurant named Luigi’s. From the décor and the smell of pasta sauce coming from the kitchen, you assume that this restaurant serves Italian food. You walk forward, your name is taken and you are then told to sit off to the side and wait until your name is called so that you can get a table. Time goes by, and no one gives you any eye contact or tells you what’s going on but you’re quite hungry and so you wait. Other people go get seated ahead of you and you don’t know why.

You finally get escorted back to a table and the host says “a waiter will be with you,” but no one arrives. Eventually, a waiter arrives and sets menus before you but this menu is written in Italian with no descriptors of the food. The waiter takes your order but you have no real idea what to expect and this particular waiter doesn’t ask if you need help, is irritated when you ask questions and gives completely unclear explanations when questions are asked.

You finally get your food. The quality may be phenomenal, but the waiter has been completely absent during most of your meal, only to appear as you are getting up to leave with a bill for $1,700.

Patients often have a similar experience when they visit the Emergency Department, but instead of Italian food, the confusion is about their ongoing health plan and ED experience. The medical care may be great, but no explanations of what to expect are given. An occasional staff member may be abrupt, and delays are frequent and unexplained. In addition, their visit looks nothing like it was supposed to according the shows they’ve seen on TV.

It is exceedingly important that appropriate expectations are set when patients arrive at the emergency  departments and it is extremely important that patients are kept updated regarding delays. Study after study has shown that when increased wait times and decreased throughput occur, patient satisfaction scores can be maintained and a positive impression made if patients are kept informed and have appropriate expectations set from the very beginning.

If you’re an ER doctor, how often have you been working an incredibly busy shift and had several patients to see when all of a sudden you hear a nurse say, “The Doctor will be in within just a few minutes”? How often have you told the patient that their labs should be back within the next hour or so and yet at the almost two hour mark those labs have still not resulted? As frustrating as these moments are for you as a provider, they are even more frustrating for a patient when some of the very first crucial information they receive from the care team is incorrect.

Several steps can be taken to help clarify expectations and keep patients appropriately informed.

Encourage triage nursing staff to have general explanations ready for what patients should expect from their time in the Emergency Room as they triage patients. Even a pamphlet would be useful in informing them.

Communicate with your nursing staff when the ED is particularly busy. Make a quick call to triage to tell the nurse to start setting realistic expectations.

During busy times, tell your staff who place patients in the rooms to inform them that it may take time for the doctor to come in but that he/she is aware of their illness and will see them as soon as possible.

Briefly touch base with waiting patients when they are in rooms to say when you believe you will be in to see them.

When there is a delay at any level of ED care, inform the patient of the delay immediately.

Keep patients up-to-date about their results. When passing rooms step fully into the room to give a 30 second update on their status and then continue to deliver care to others.

Inform your nursing staff of the plan and of de- lays so that when the patients ask questions of the nursing staff, it is clear to the patient that the entire ED care team is cooperating and clear regarding their care.

These steps take less than a full minute each to implement, but will impact the patient satisfaction scores on your emergency department and raise your patient’s view of you as a physician tremendously. Emergency physicians should aim to improve the patient experience for every patient at every encounter. Delivering clarity as to what to expect and then frequently supplying clear information about the patient’s ongoing care is a sure way to continue make sure patients stay appropriately informed.

Patsy McNeil, MD, is an emergency-room physician who blogs for MEP Health (www.mephealth.com), an emergency and outpatient care partner for hospitals.