by Joanna Smith, LCSW, MPH
As a health-care advocate working with hospitalized clients and their treatment teams, I’ve seen firsthand some of the communications shortfalls that occur during the transition from the hospital to post-acute care.
A recent example involved a distraught father on the phone whose hospitalized 15-month-old daughter was having trouble breathing and needed suctioning every 15 minutes. He told me the hospital was ready to discharge his daughter, and he could not understand how this could be rationalized given her condition.
Unfortunately, this is not an unfamiliar story. Clear communication – a guiding principle of effective patient transition – isn’t easy to achieve. The news may not always be good, but physicians, case managers and discharge planners need to provide patients and their families with timely information.
Here are six key guidelines for effective patient-transition communications:
1. Start Discharge Planning the Day of Admission.
The moment someone enters the hospital we have to think about the discharge plan. Too many times patients say, “I’d never met this person before, and she came in one morning and said I was going home that afternoon.” Some of the most difficult discharge-planning scenarios occur because the process is too abrupt, and patients and families get scared. If a patient looks “low priority” on admission, that does not mean we can wait to “get to them” until the day they are discharged. Much of the resistance we encounter at discharge might disappear if discharge planners and case managers introduced themselves on the day of admission.
2. Assign a Point Person.
Communicating through team meetings with the family in extremely complex medical situations may not be the most effective choice. Families frequently call me for help after these kinds of meetings. “There were all these people in the room,” they say, “and we couldn’t remember what they all do; they were trying to tell us how things were going and we couldn’t understand them.” Instead of a “team meeting,” why not call it a “family update” and pick one person to meet with the family? This approach is less intimidating and can be more effective. Families will not be overwhelmed.
3. Use Simple Language.
It’s easy to forget that the world of medicine is an alternate universe with its own language, customs and behaviors. Patients enter this medical world and encounter all of the problems of cross-cultural travel. In addition, they are very ill and do not have the resources to think and analyze information well. Even their family and friends may not understand our language. If we drop medical jargon from our explanations and repeat explanations as needed, the families we work with will have a greater probability of understanding us. Stressed families can only absorb a limited amount of information at once. They need to hear it multiple times so they can move to a point of decision-making.
4. Explain Care Coordination.
The system of care has changed — and most patients do not know it. They do not understand the hospitalist system and still expect their family physician to follow them into the hospital. It’s a shock to learn that may not be the case. Families may already be struggling with a new diagnosis or a poor surgical outcome, and a different system of care adds to the stress. Be prepared to explain the care-coordination system and provide reassurance that their primary-care physician will get a report of what happened during their hospital stay.
5. Make Decisions Transparent.
Patients and the medical team look at decision-making in very different ways. Patients frequently believe their provider can get information (from labs, scans, biopsies, etc.) and simply make a decision about the best treatment option. In reality, decisions are more complex. The health-care team looks at the information, tries to judge what might work best, integrates more information, changes their minds and may suggest something else. Treatment plans can shift quickly. Understandably, the process may look chaotic to patients and families. In the end, we hope to find care that works and enhances the patient’s quality of life. We need to communicate how and why we do what we do.
6. Show Sensitivity.
We hear this all the time: “I promised I’d always take care of them,” or “I promised I’d never send them to a nursing home.” We need to help people look beneath those words to what they were really promising — to care for their family member in the best way possible. It’s important to have these discussions because it helps move families from feeling guilty about their care decisions to feeling peaceful about them. When they have made that shift, options that did not seem possible before can emerge and ease the transition to the next level of care.
For the distraught dad and 15-month old I mentioned, their health-care team could have spared the father aggravation and confusion by adhering to each of these points, especially establishing a trusted point of contact who was proactive and forthcoming with clear information.
Joanna Smith, LCSW, MPH, is CEO of Healthcare Liaison, Inc. of Berkeley, Calif. She is also founder and president of the National Association of Healthcare Advocacy Consultants.
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