Creating scripts for consistent complaint responses

Rationale: In response to concerns regarding the enforcement of various ETC policies, we have created scripts to be used by all ETC staff and volunteers in order to communicate a more consistent and consumer-friendly message. Ideally, stating the appropriate policies to all new patients and their visitors when taken back to the treatment area will save time and frustration for all staff members. In addition, the flow of visitors, as well as their inappropriate behaviors (i.e., eating/drinking at patient’s bedside, wandering in and out, etc.) should decrease. Remember, our approach and how we communicate with patients/visitors is equally as important as what we say. When possible, apologize for the inconvenience, give an explanation, and offer an alternative. Hopefully, this will help to prevent any power struggles.

RE: Signing out against medical advice

"You are signing out AMA—against medical advice. The danger in that is that your medical treatment has not been completed and we have not yet determined what is wrong with you. The risks involved in your leaving are (explain appropriate risks). Please understand that you will be billed for services received thus far. Also, if you leave now and then decide to come back, you will have to start the registration and triage process all over."

RE: Wait times

In order to relieve wait-related anxiety and to increase the patient’s understanding of why they are waiting, we need to be proactive in giving wait time explanations after every contact with the patient (even if you are just re-stating what you have already told them). Below are some examples:

Physician: "I want to have some blood work done up on you. It will take us approximately one and a half hours for the lab to complete all the tests ordered."

Nurse: "Your physician wants to admit you to the hospital. We have a few things to be done down here first.We anticipate that you will be in your room in about two hours."

• Being specific/concise in your word choice will help to lessen any misunderstandings. Telling a patient that you’ll be "right back" or that you’ll get them discharged "shortly" may mean something much different to them than what you intended.

Re: Calling the patient’s physician

When a patient/family member requests that you call the patient’s physician, explain to them what the appropriate procedure is. For example, tell them that they will be examined by an ETC physician first, who will determine the immediate course of treatment. After they have the necessary information and test results, they will then get in touch with the patient’s physician if appropriate. Explain to them that private physicians don’t generally want to be called until the ETC physician has information to tell them, and that if you call his/her physician now, s/he will just tell you to get in touch with him/her after the patient has been seen.

RE: Food/drink policy

"I’m sorry. Unfortunately, due to infection control regulations, visitors are not allowed to have anything to eat/drink at the patient’s bedside. I’d be glad to keep it for you out in triage."

• Be prepared to explain why the patients are allowed to eat or why they may have seen staff members eating or drinking.

RE: Visitor policy

A. In general: "I can allow two visitors at a time to go back to see the patient. We ask that you stay at the bedside and limit your trips in and out. There may be times when we need to do certain procedures and will ask that you step out; please wait in the waiting room. Also, there may be times when we need to limit all visitors; we ask for your cooperation during these times."

B. When limiting all visitors: "I’m sorry, we are asking to not have any visitors for the next (estimate time) due to (explain reason)."

• Be willing/offer to take a message to the patient if needed.

C. Ob/Gyn visitation: Patients going back to the Ob/Gyn rooms may have male visitors accompany them. When approaching those rooms, ask any visitor, male or female, to wait outside that area until you can check to be sure that another patient is not in the middle of an exam.

When taking the patient and her visitor back, let them know that the area where you are going is for women who often need pelvic/female examinations, and it is important for us to maintain our patients’ privacy. Explain that for that reason, visitors will be asked to step out for a short time when any patients need to be examined.

• Before an exam, make a general announcement to the room that all visitors will need to leave. Let them know they are welcome to return in (estimate time). If you are unsure how long it may take, let them know you will call out when they may return.

• Keep in mind that some patients prefer to have their "significant others" with them during the exam. Please be willing to accomodate the patient’s wishes, when possible.

• There have been many times when a patient has had numberous (hundreds, it seems!) visitors who keep coming in and out. Staff needs to be willing to speak to the entire family and explain to them that the constant coming and going is disruptive to both the patient and the staff trying to provide the patient care. If you have to limit the visitations, make sure the patient is aware of the situation; s/he may be very helpful in controlling his/her own visitors.

RE: Triage process (explaining the order of events)

"Hi, I’m the triage/check-in nurse. What brings you here today?" (Do not ask "Why are you here?" Many patients perceive the question phrased this way as being confrontational in nature.)

"What I need to do is get some preliminary medical information from you, including your blood pressure and temperature. Then, I’ll have you have a seat in the waiting room and we will get you registered. When we have an appropriate bed available for you, we will take you back to the treatment area to be seen by a physician."

A. If too busy to triage immediately: "Please have a seat in the waiting room and I’ll be with you in a few minutes."

• Damage control: If it’s quite busy, be prepared to give estimated wait times before patient will be seen by a physician and/or how many people are in front of them. Help them to understand that you are waiting on a particular type of bed that is appropriate for them, and that, at this time, there are none available.

RE: Excessive outside phone calls about a patient

"Unfortunately we have had a large number of phone calls regarding this patient, and, while we realize you are concerned about your family member/friend, all I can tell you at this point is that s/he is here being treated and is in _________ condition."

• Offer to let the patient know that they called and/or take the caller’s name and phone number and give it to a family member who may be present.

• If they ask to speak with the patient’s nurse, explain to them that you are unable to have the patient’s nurse come to the phone because s/he is currently treating patients and that we try not to take the staff away unless it is urgent. (Offer to get a family member if one is around.)

RE: When there are no rooms available

"Unfortunately, right now I don’t have any beds open that would be appropriate for the treatment you need. If you’ll have a seat in the waiting room, I’ll get you back just as soon as a bed opens up. In the meantime, if you see us taking back other patients, don’t think we’ve forgotten about you—it’s just that we may have an open bed that is appropriate for the medical care that patient needs."

Source: Miami Valley Hospital

If you are unsure how long it may take, let them know you will call out when they may return.

• Keep in mind that some patients prefer to have their "significant others" with them during the exam. Please be willing to accomodate the patient’s wishes, when possible.

• There have been many times when a patient has had numberous (hundreds, it seems!) visitors who keep coming in and out. Staff needs to be willing to speak to the entire family and explain to them that the constant coming and going is disruptive to both the patient and the staff trying to provide the patient care. If you have to limit the visitations, make sure the patient is aware of the situation; s/he may be very helpful in controlling his/her own visitors.

RE: Triage process (explaining the order of events)

"Hi, I’m the triage/check-in nurse. What brings you here today?" (Do not ask "Why are you here?" Many patients perceive the question phrased this way as being confrontational in nature.)

"What I need to do is get some preliminary medical information from you, including your blood pressure and temperature. Then, I’ll have you have a seat in the waiting room and we will get you registered. When we have an appropriate bed available for you, we will take you back to the treatment area to be seen by a physician."

A. If too busy to triage immediately: "Please have a seat in the waiting room and I’ll be with you in a few minutes."

• Damage control: If it’s quite busy, be prepared to give estimated wait times before patient will be seen by a physician and/or how many people are in front of them. Help them to understand that you are waiting on a particular type of bed that is appropriate for them, and that, at this time, there are none available.

RE: Excessive outside phone calls about a patient

"Unfortunately we have had a large number of phone calls regarding this patient, and, while we realize you are concerned about your family member/friend, all I can tell you at this point is that s/he is here being treated and is in _________ condition."

• Offer to let the patient know that they called and/or take the caller’s name and phone number and give it to a family member who may be present.

• If they ask to speak with the patient’s nurse, explain to them that you are unable to have the patient’s nurse come to the phone because s/he is currently treating patients and that we try not to take the staff away unless it is urgent. (Offer to get a family member if one is around.)

RE: When there are no rooms available

"Unfortunately, right now I don’t have any beds open that would be appropriate for the treatment you need. If you’ll have a seat in the waiting room, I’ll get you back just as soon as a bed opens up. In the meantime, if you see us taking back other patients, don’t think we’ve forgotten about you—it’s just that we may have an open bed that is appropriate for the medical care that patient needs."

RE: Clerical incoming phone calls

Rationale: In response to concerns regarding the seemingly increasing number of incoming phone calls, we have created scripts to help appropriately triage the calls. This should help decrease the number of calls needing to be transferred, make sure the transferred calls make it to the appropriate area, and help to keep your phones/desks clear from people utilizing them for phone calls.

Patient Inquiry Phone Calls:

When patient inquiry phone calls come in, first verify if the patient is here, and then where the patient is. Before giving any information, be sure we can even acknowledge that the patient is here!

If the patient is still listed in the waiting room:

"The patient you are calling about is currently waiting to be taken to the treatment area to be evaluated."

• If requested, take message and then call patient up to window and give them the information . . . this will cut down on the amount of patients who are utilizing your phone for calls.

• If the caller is insistent upon speaking with the patient, page the patient to your desk, tell them that they have a phone call and may use your phone, but to please make it brief.

If the patient is in a treatment area:

"The patient you are calling about is currently being evaluated in our treatment area. I am sorry, but we cannot give you any other information over the phone."

• If the caller is insistent that they need to speak with the patient, try to take a message and/or determine if the patient has visitors here that can take the phone call. Otherwise transfer the call to the back. (If you take a message and are busy, you can utilize the volunteers or patient representatives to get the message to the patient/visitors.)

• If the caller is insistent that they need to speak with the patient's nurse or physician, transfer the call to the back.

Source: Miami Valley Hospital