Your actions can reduce tension over long ED waits

Show patients you care

What's the most common complaint that Amy M. Kirkland, CHAA, patient access team leader for the emergency department at Palmetto Health Richland in Columbia, SC, hears from patients? Hands down, it involves frustration over long wait times.

"This is the biggest complaint I see. But patient access has no control over this," says Kirkland. To defuse tension, she relies on honest, direct communication.

"If patients understand why things are taking so long, most of the time they are not as irate," says Kirkland. "Hourly rounding in the emergency department lobby by patient liaisons and assistant nurse managers is one way we connect with our patients and inform them of delays."

Patients are often unhappy to be asked for co-payments or deposits. "They feel that we are not concerned about their care but only about the money," says Kirkland. "It is important that patient access perform their job duties in a manner that delivers compassion, just like the patient's nurse is required to do."

Even though patient access is not clinically involved in the patient's care, the way you present yourself matters a great deal. "In no way do you want your patients to get the perception that you are just there for their money," says Kirkland.

Although Susan Thompson, director of admission services at Moses Cone Health System in Greensboro, NC, says her department does not see many angry patients, the emergency department is an exception when wait times are long.

"Morale goes down a bit when we have a very high census. Staff cannot spend the time they want to with patients, and I think that bothers my employees more than anything," says Thompson. "Some patients feel they weren't treated appropriately when they come by and clear discharge. Oftentimes, they do not want to pay copays and use the excuse of excessive delays."

Other than requesting that payment is made when the service is rendered, staff do not "push" for any money from the patient. "We do see patients who say, 'If I had known it would cost this much, I never would have come here.' But because of EMTALA, we can't tell them in advance what it will cost," says Thompson.

The biggest collection challenge for the system's two EDs is actually getting patients to come by discharge before leaving. "There are too many egresses where patients can bypass us altogether," says Thompson. "At this point, we simply have a cashier who asks for copays. You can walk out right now and never see us. Our goal is that a clinical person will escort that person to discharge, but sometimes the patient gets impatient and walks out beforehand." To address this, the hospital is considering putting a financial counselor in the ED and plans to redesign the area during a planned renovation.

Another possible solution is to collect copays in the treatment room, once the patient has been assessed by a physician and is stabilized. "The challenge is that you may have to go back into that room three or four times before the patient can actually talk to you. You don't know whether a nurse or phlebotomist is in there or whether the medical screening examination has actually been completed," says Thompson. "The goal is to give them a courtesy discharge, so that everything is taken care of and the patient can save some time. We think it will be a win-win for everybody if we can achieve that."

When asking for a copay, "we basically try to hold to the same script. We say, 'These are the estimated charges for this procedure or visit. How will you be making payment today? Credit card, check or cash?' That kind of negates the possibility of the patient telling you 'I'm not prepared to pay anything,'" says Thompson.

If patients are upset, however, they aren't asked for a copay. Instead, staff say that they sincerely apologize for the excessive wait. That patient is given the hospital's service excellence phone number so they can report their concerns.

"If the patient is truly irate and think their care wasn't appropriate, we get the director of nursing or the house coverage down to see that patient, if available," says Thompson. "And we will always give service excellence a heads up so they can communicate with the family to defuse it as quickly as possible — if not right then, then within 24 hours."

If the patient cannot pay the full balance, a partial payment is taken instead. "We state that they can follow through with patient accounting when they receive their bill," says Thompson. "At this time, we don't reschedule or postpone procedures if the patient cannot pay, with the exception of a very few elective procedures including cosmetic or bariatric surgery."

When scripting is used, however, it is tailored according to the staff person's own unique personality. "We take each patient as an individual. We try not to sound like we're scripting. I don't want my employees sounding like robots," says Thompson.

For example, if patients are very upset, staff offer to call them back if it's not a good time, or give a phone number so patients can contact them when convenient. "Just being empathetic is the important thing," says Thompson. "If the patient is very worried or upset, my employee may get me or a supervisor involved. In that case, the patient is told, 'I want you to feel comfortable, and here is someone who may be able to shed additional light on this.'"

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