No bed available? Keep patient satisfied anyway

Explain reasons for delays

If a worried and anxious patient or family member is kept waiting, it might help to convey the underlying reasons for delays in registration, treatment, or room placement, says Diane Manuel, director of patient access for admissions and the emergency department at Wake Forest University Baptist Medical Center in Winston Salem, NC.

Lack of available beds is the typical reason for delays in the hospital's inpatient areas, according to Manuel. "What normally keeps a patient waiting is we do not have a bed assigned, or it is not ready for the new patient when they arrive," she says. "We don't do bed assignment in our department. We depend on clinical areas to assign the beds."

The concept of specialty units are hard for patients to grasp, says Manuel, and they might not understand why they can't be given an available bed on a different floor. "We just try to explain as kindly as we can, the real reasons they are having to wait until a bed is empty or ready," she says. "We always apologize and tell them that we understand this is inconvenient."

In the inpatient lobby, management follows up with all waiting patients and family members at 15- to 20-minute intervals. "We support both our inpatient and ED registration staff, by providing management intervention whenever we are notified of the need," Manuel says.

Registrars make an initial attempt to explain the delay to waiting patients and family, says Manuel, but that isn't always enough. "If it gets to a level that a registration person senses that the patient or family is not satisfied with their explanation, they let us know right away," she says.

On Memorial Day, for example, four families in the inpatient admitting area were angry because they didn't have bed assignments, so Manuel came to speak with them directly. "They could not understand why they didn't have a room, when a reservation was made a week or two in advance," she says. In this case, Manuel told the families that if 50 of the hospital's 100 beds are filled, and 50 emergencies come in on a given day, the available beds have to be filled with the emergency cases right away. "I explained that I can't hold those beds for the patients who have reservations the next day," she says.

Here are other steps taken by the hospital's registrars:

• If a patient waits longer than 30 minutes to be admitted, registrars give the patient a meal ticket for the hospital cafeteria.

"This allows the patient to take a break from waiting," says Manuel.

• Registrars tell patients they will check every five minutes to see if a bed has become available.

• Registrars provide beverages to patients.

A coffee and water cart was added to the inpatient lobby during periods of high census, on a trial basis. "After realizing the positive effect of the refreshment cart, we chose to continue providing this service for our patients and families," says Manuel.


For more information on keeping patients satisfied while waiting, contact:

• Diane Manuel, Director of Patient Access, Admissions, and Emergency Department, Wake Forest University Baptist Medical Center, Winston Salem, NC. Phone: (336) 716-3312. Fax: (336) 716-0623. E-mail: