Having a patient advocate dedicated to the ED

Manager creates new position, then fills it herself

Good ED managers are adept at identifying problems in their department and coming up with innovative solutions, but how many of those solutions involve a title and position change for the managers themselves? That's exactly what happened at St. Mary's Hospital in Tucson, AZ, where Cassandra Pundt, RN, CEN, who had been the ED nurse manager for 10 years, created and then filled the new position of ED patient representative.

Patient advocates, or representatives, are common at many hospitals, but few EDs are fortunate enough to have one exclusively devoted to their patients and families. Why did Pundt believe this was so important, and how did she sell it to management?

"With all of the challenges emergency services face — with increased volume of patients, more and more patients coming in to use the ED as primary care, and our population of 'boomers' booming — we've see increased utilization of services and, along with that, more challenges for throughput," Pundt says. "As a manager, you must deal with everything regarding patient and family complaints and quality of care issues, and you have your hands in so many pots, it's difficult to keep up with it all."

Inpatient services had nurse/advocates covering all nursing units, but Pundt thought the ED needed its own to enhance the timeliness of responding to patient and family complaints, quality issues, and customer service training.

Diane Foster, RN, BSN, director of emergency services, agrees. "I think the nature of what we are dealing with here is unique, particularly because of the vast variety of patient population we are dealing with in one environment," she says. "You really have to be physically in the department and a part of that whole team to understand what is needed." In addition, she says, the department's goal is to be proactive; to prevent problems and satisfy delivery of care needs the first time, rather than having to go back afterward and deal with complaints.

Selling the idea

It was really not that difficult to convince administration to create the position, Pundt confesses. "I wrote the job description and presented it to my director in nursing leadership, and the position was approved in August of 2006," she recalls.

The fact that there were others to fill her position as nurse manager made the transition a bit easier. "In terms of replacing me as manager, I had two assistant managers — one who was on days and one on nights," she explains. "We took the nursing director I had [Foster] and dedicated her time to just emergency services, and the other departments took up that slack." The ED, she says, now has a director, a patient representative, and two co-managers.

Why did Pundt decide to fill the position herself? "I'm getting ready to retire in a couple of years and wanted to transition into something less stressful than management," she explains. "Also I thought that getting back into really close touch with the patients and families would be rewarding, which it has been."

Her job is multifaceted. For example, in addition to interacting with patients and their families, she trains the staff in customer service and communication techniques, such as how to professionally communicate with patients and family members, and how to deal with difficult individuals. "I also work with some of our outside clinics that support our uninsured or underinsured patients who do not have a primary care physician," Pundt adds. "I refer patients like that on a daily basis."

Of course, she also spends a lot of time addressing patient and family concerns. Documentation and investigation, she adds, takes a lot of time. "Sometimes an issue will take the form of a grievance, which requires a committee to meet and review the complaint; sometimes it may go to quality or maybe back to the director for associate counseling or physician counseling," she says.

While Pundt works during the daytime, she is virtually on call 24/7. "She has a cell phone and is always available, and sometimes a lot can be done by phone," says Foster.

Pleased with results

Pundt and Foster are pleased with how the new position has worked out.

Foster says, "I think it's been extremely successful. We've seen improvement in patient satisfaction scores."

While the department, which is surveyed by Lincoln, NE-based National Resource Corp. (NRC) Picker, is "not yet in the top 10%," Foster says that in the category of overall patient experience, "we are performing better than the comparison group we benchmark against." Pundt says, "We've also seen improvement in several dimensions of care, like physical comfort, respect for patient preferences, and access and coordination of care."

Picker also keeps Pundt informed on a regular basis. "I receive alerts from them if comments come back on the survey, and then I follow up with those patients," she says. "I may then discover a quality-of-care issue, in which case I refer it to the quality manager or risk manager for review, and I always keep my director informed."


For more information on creating a patient advocate for the ED, contact:

  • Diane Foster, RN, BSN, Director of Emergency Services, St. Mary's Hospital, Tucson, AZ. Phone: (520) 872-6001.
  • Cassandra Pundt, RN, CEN, ED Patient Advocate, St. Mary's Hospital, Tucson, AZ. Phone: (520) 349-9817.

For more information on patient satisfaction surveys, contact: NRC Picker, Lincoln, NE. Phone: (800) 388-4264. Web: nrcpicker.com.