Health network launches effort to improve safety

Many health care providers are considering adopting the idea of a hotline that patients and family members can call when they think their concerns are being taken lightly by their immediate caregivers, but some risk managers might wonder if the phone will be ringing off the hook with trivial complaints and misunderstandings.

That has not been the case for the Community Health Network (CHN) in Indianapolis, which recently launched a new patient safety initiative in all of its hospitals, referred to as Call FIRST (Family Initiated Rapid Screening Team). CHN has five hospitals in Indianapolis (Community Hospitals East, North, and South, Community Hospital Anderson, and The Indiana Heart Hospital) as well as almost 70 more facilities throughout the state. The Call FIRST effort encourages patients/and or families to make a simple phone call when there is a change in the patients' condition and they feel their concerns are not being addressed.

Internal phone lines designated

A designated internal phone line at each of CHN's hospitals has been established for this program, explains Trudy Hill, clinical patient safety officer for CHN. The hotline is part of an overall effort to create a culture of safety at the hospitals, she says, and it is intended as a safety net if all other efforts have failed up to that point.

When patients or families use Call FIRST, a nursing supervisor or consult nurse will provide help within 15 minutes at the bedside to evaluate and stabilize the situation. The program is not intended for routine questions or concerns; rather, it is intended for serious concerns in the change of a patient's condition. If the patient or family discusses the issue with the health care team and there is confusion about the condition or treatment plan, Call FIRST also can provide assistance.

"Call FIRST is an immediate response to any serious concerns about a patient's care in any one of our hospitals," Hill says. "By calling the designated Call FIRST line at each hospital, patients and families can receive a fast response about what is happening in the care process so that it can be addressed in a very timely fashion."

Call FIRST signs have been posted in rooms and other patient areas to make patients and families aware of the initiative, and patients are given a brochure describing the program on admission.

Skepticism not uncommon

CHN is not the first to use a patient hotline as a safety net, but its experience is helping dispel one of the common concerns about such programs. Nurses, in particular, tend to worry that patients will use the hotline to complain unnecessarily and they will be punished as a result. For instance, the web site www.allnurses.com includes a forum discussion of the CHN Call FIRST program in which nurses express skepticism. (Editor's note: See the discussion online at allnurses.com/forums/f195/ here-call-first-program-250768-2.html.)

One nurse posted a message with worries that the hotline will be used by people who "generally complain about little things" and patients who "complain about not important things." Another writes with concern about "how many people will abuse this, and use it when they don't really need it. At our hospital, we've already had patients push the 'code blue' button to get a nurse to bring him/her water ..." That nurse also said "there are very needy people out there that forget they are in a hospital and believe they are in a resort."

None of those problems have occurred so far, says Eleanore Wilson, MA, BSN, RN, vice president of nursing at Community Hospital North. "We emphasize to them this is not to be used for routine calls or just complaints," she says.

Community Hospital North began the Call FIRST program on Sept. 1, 2007, and through the end of November 2007, the hotline was used only two times, Wilson recalls. Community Hospital East received four hotline calls in a slightly longer time period, and the other hospitals have not received any, she says.

In the first case at Community Hospital North, a patient was concerned about a gurgling sound from a chest tube and did not understand the explanation from his nurse, so he called the hotline for help. The Call FIRST member responded right away and explained that the sound was normal, which satisfied the patient and his family.

In the second case, a diabetic patient was unhappy with a change in his usual medication and called the hotline for help. A nurse manager explained why the medication was changed and gave him more detail than his nurse initially had provided. "I think he just wanted to hear it from someone else to make sure it was right," Wilson says. "We consider both of those cases an appropriate use of the call. We don't want patients to feel uncertain about their care, but it doesn't necessarily mean anyone at the bedside did anything wrong either."

Wilson says the nurses at her hospital were skeptical about misuse of the Call FIRST program initially, but then they attended an education session that included the story of Josie King, an 18-month-old girl who died in January 2001 at Johns Hopkins Hospital in Baltimore due to medical errors, along with the mother's inability to get staff and physicians to listen to her concerns. That death prompted the creation of the "Condition H" (for help) hotline at the University of Pittsburgh Medical Center Shadyside in Pennsylvania and similar projects at other facilities. "When we introduced this we really stressed to the staff that this was not about second-guessing them or trying to catch them in a mistake. Sometimes the patient just needs to hear from someone outside their immediate circle of care, and this number makes that possible," she says. "The Josie King case really drove home how a resource like this can prevent a tragedy."