Improving Patient Communication
A bunch of people bit my head off on my A Better Way To Round post, assuming that I was ignoring patient communication. Idiot Savant’s comment pretty much sums it up–the point I was making was that because we spend so much needless time rounding, we often lack time for patients, in terms of communicating properly, frequently, and promptly, updating them and them families, doing procedures, etc.
I want to improve rounding so that we medical students, interns, residents, fellows, and attendings have more time for more important stuff than collecting numbers from a computer screen and copying them down multiple times. (Each person in the above list spends at the very, very least one hour doing this. Every. Day.)
Other ideas for improving patient care and communication:
- A little notebook and pen for every inpatient. They write down their questions, and when we stop by we answer them. Easy.
- For the less acute patients who are needing to reach some goal before discharge (I’m particularly thinking about fluid-retaining CHF patients who need to diurese but go to the cafeteria way too often): A calendar where they can list their daily weights, to motivate them. This could be applied to other patient populations as well.
I actually totally agreed with you on your previous post. My team wastes so much time “rounding” every day, there really has to be a better way of doing it with our modern era of e-records.
I also think we’d improve patient care with a well-written manifesto on “why you need to leave this hospital STAT for the sake of your own health…”. I hate seeing healthy people who come down with pneumonia, MRSA, and CDif that really didn’t have to happen.
I had a surgical rotation once where we rounded 8-12 hours a day sometimes. The census was huge (60+ patients), the team small (3 interns, 1 chief, 4 clueless med students, 1 very slow attending) and the task was utterly hopeless. Patients would stay longer because no one could plan appropriately for discharge because there was just too much to do. We’d round so long that stuff wouldn’t get done–when are you going to order that CT and obtain the report when you’re stuck in rounds? So I entirely agree with you, both in your criticism and in your suggestions for improvement.
You are absolutely right. So much time is wasted in processes that “we’ve always done a certain way”. I don’t think we are embracing EMR to the nth degree but there should be a better way to round. Maybe all the patient data could be downloaded automatically into your blackberries.
Also that CHF patient could be treated at home with telemedicine after he is stabilized and wouldn’t have to trot down to the cafeteria for entertainment or pick up a MRSA infection. We don’t do enough with education for staff and patients.
Great post. With the amount of mobile technology that is out there now, it is time to make a switch that streamlines the rounding process. Even if team members had to carry around a small tablet PC, the ability to access information in real time from any location would be well worth the trouble. Plus, algorithims could be built into the software to provide alerts when necessary, etc.
Why this hasn’t been implemented or at least tried yet is beyond me.
Rounds at Boston’s Lemuel Shattuck Hospital Geriatric Care Services and Rounds at the Shattuck Hospital Intensive Care Unit ICU have are not encouraging patient doctor communication. Patient questions are not solicited in a communicative manner.