Keep patients satisfied, even if waits are long

Information is the key

While you wish that no patient ever had to wait in any registration area, that's not realistic due to patient volumes and other factors beyond the control of your department.

On the positive side, though, there is evidence suggesting that an informed patient is a happy one, even if he or she is kept waiting.

Patients who waited more than four hours in the emergency department, but received "good" or "very good" information about delays were just as satisfied as patients who spent less than one hour waiting, according to Press Ganey's 2010 Emergency Department Pulse Report.

Lisa A Cox, CHAM, admitting manager at Maine Medical Center in Portland, says she has found this to be true.

"We have found that customers that wait a long time for their bed, but were kept informed and checked on during their wait, were happy even thought they had to wait," says Cox.

Cox says this is the responsibility of both the access rep who admits the patient and the front desk access rep. Updates are given every 10 or 15 minutes.

"Patients like to have a contact person, so they can ask questions and let us know if they need anything," says Cox. "The access rep ensures that the patient has their name and knows where to find them."

The patient and family get meal passes, and a flower is sent to their room with a note saying, "Sorry for the wait." This approach has paid off, according to surveys by hospital volunteers.

"Volunteers go to each unit and survey the patients on their experience and how they were treated by the admitting area," says Cox. "We received positive comments about waiting for a bed if patients got to eat lunch on us, or they had a nice flower in the room when they arrived."

Informed patients are less nervous about their stay compared to those who are not told why they are waiting. "This can be seen in their body language," says Cox.

Sheri Lasater, manager of patient access for Penrose-St. Francis Health Services in Colorado Springs, notes that patients often interact with patient access staff before interacting with members of any other department.

"It is the responsibility of patient access associates to start the visit off on the most positive and professional note that they can," says Lasater.

Even if patients receive the best clinical care and outcomes possible, they will always remember any portion of their visit that they perceived as negative.

"It is crucial that the patient access associates give patients positive things to remember, right from the moment they enter our facility," says Lasater.

Patient access associates often need to act as the liaison between clinical departments and waiting rooms. This is a difficult role for several reasons.

"Patients arriving for scheduled procedures typically have the least amount of wait time, and present fewer challenges," says Lasater. "However, many patients are seen on a walk-in basis and are prioritized by acuity."

This can be very difficult for patients to understand, especially when they see others receiving care outside of a "first-come, first-served" system.

"It is important for patient access staff to be given accurate and appropriate scripting that they can use when explaining patient prioritization based on acuity to patients who are waiting," says Lasater.

Patients may wrongly believe that long wait times for available inpatient beds are the fault of patient access.

"In order to clear up the misconception of these patients, we explain that patients have a discharge time of 11 a.m.," says Cox. "However, that time is not enforced since patients cannot leave until their physician is able to give them the OK to go."

Physicians work to ensure patients are discharged quickly, but sometimes testing may delay the discharge. "As soon as the bed shows as dirty in the bed tracking system, environmental services will be ready to clean the bed, stat," says Cox.

Lasater says that, occasionally, scheduled patients are kept waiting because other patients presented to the emergency department for traumatic injuries. The injured patient might require procedures on the same equipment that was reserved for the scheduled procedure.

"This can be one of the most difficult waits to explain to a patient," says Lasater. "Patients with a scheduled appointment have a hard time understanding that they could be 'bumped' for an emergent patient."

Emergency department patients also are often subject to lengthy wait times, due to high volumes of patients needing to be seen at the same time. "Certain times of the day, week, or year produce extremely high emergency department volumes," says Lasater. "Patients are often required to wait for very long periods of time before resources — rooms, physicians, or nurses — are available."

Be clear about why

Lasater says that the most important thing that patient access staff can do for patients who are waiting is "effectively and positively communicate the expected wait times. When patients know what to expect, it is much easier for them to accept that they will have to wait for their care to be provided."

Keep in close touch with waiting patients and offer to get updates on how much longer they might have to wait. "Patients appreciate proactive staff members who approach them with updates. They prefer not to have to keep asking staff how much longer they might have to wait," says Lasater.

Patients waiting in the ED are listed on an electronic waiting room tracking board. All staff working in the department can access this.

"Patients are sorted based on length of wait, so it is simple for staff to know which patients have been waiting the longest," says Lasater. "This helps staff to know which patients to approach first with updates."

For other areas, staff have learned to manually keep track of patients in the waiting room. They call clinical departments for updates at regular intervals.

"Patients who are waiting do not have access to speak with the clinical department that the patient will be visiting, but patient access associates typically do have that ability to act as a liaison between the patient and the clinical department," says Lasater.

A clinical staff member may be available to discuss the wait with the patient directly. "This can oftentimes be very helpful," says Lasater. "This is particularly easy to achieve in the emergency department, but can take additional coordination in non-emergent areas."

Patients may want to hear information about the wait directly from clinical staff. "It often makes them feel that they are beginning to move through the flow of patients, because they have now had the opportunity to speak with a clinical professional," says Lasater.

[For more information, contact:

Lisa A Cox, CHAM, Admitting Manager, Maine Medical Center, Portland. Phone: (207) 662-4413. E-mail: coxla@mmc.org.]