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I completed my medical school and background EM training from India (Christian Medical College, Vellore and Apollo Hospitals, Hyderabad) where I worked for 4 years. Following this, I devoted (with all my heart) about 1.5 years to do US Medical Licensing Exams. My stint towards an EM Residency in States did not work but it took me to places and it has been quite a journey. I then relocated to London, England to work as a Registrar (Non-Trainee) in A&E. This gave me an opportunity to better understand NHS, EM training pathways and more importantly the EM Mindsets in the United Kingdom. 

Currently, I am pursuing Higher Specialist Training in Emergency Medicine at South East Scotland Deanery where I have the honour and privilege of training under some of the most innovative brains in the field of Emergency Medicine. Over the past few years, I have realised that LEARNING and UNLEARNING (which can be challenging!) is equally important to deliver cutting edge care to our patients.And through this blog, I aspire to disseminate knowledge, assist trainees with exams and stay up to date with contemporary EM literature. I have always been an avid FOAMed supporter because FOAMed has always played an indispensable role during my training. 

Lakshay Chanana
ST4 EM Trainee 
Edinburgh, Scotland

Monday, February 1, 2016

Improving patient satisfaction

Emergency Departments represent the face of a hospital and it is based on the kind of care delivered in the ED, patients judge the institute overall. So it becomes extremely important for us, as emergency physicians to focus on this "customer care" part of our practise. I often equate a busy ED with a busy restaurant, where if someone treats you well, you always tend to remember that particular service provider. The only difference is that in a restaurant, you are less likely to get sued if your customer is unhappy! They might just swear at you and move to another one. On the other hand if they leave satisfied, they are more likely to use the same service again.

Most patients do not understand about the practical details of the processes and the treatments they go through in the hospitals. And for them an up to date evidence based care is not essentially equal to satisfactory care or a satisfactory experience. They don't care about sepsis goals or whether you are sticking to the guidelines or not. Here are a few things that we can do to improve patient experience in the ED:

1. See them as quickly as possible
Nobody likes to wait and that is human nature. Everyone wants to be attended ASAP. So one way to do this is physician assisted triage that demands extra staffing OR set up a fast track unit where minor ailments are handled quickly without interrupting the flow. The key is keeping the fast track close to the normally functioning ED, otherwise patients may perceive this as lack of attention on the physician's part. 

2. The way you Communicate and your body language matters: Once again, undoubtedly the most important component. Click here to read more on communication. 

3. If you made them wait, Apologise - Patients can get really annoyed if they are made to wait for too long. If this happens for whatever reason, just apologise without giving any sort of explanations because the one who is waiting does not really care. 

Physician: I am sorry to keep you waiting for so long, there was a really sick patient in the ED
Patient: Okay doctor, so you want us to land up in that critical state and only then you will attend me.

Engage them with something (brochures, television) while they are waiting and keep them posted about what is happening. Don't leave anyone unattended for more than 10-15 minutes. Make sure someone talks to them and resets their clock (it can be a physician, nurse, intern or a med student). This make a huge difference between the actual and perceived waiting times. Also remember that even minimal delay can seem long to an anxious patient, while longer delays may be well tolerated by patients at ease with events and confident that they are being looked after seriously. 

Everyone who speaks with the patient—including nurses, physicians, lab technicians, and radiologists—must inform the patient about what will happen next and roughly how long it will be until it happens. This information once again resets the patient’s clock. 

4. See things from their perspective: All subsequent caregivers must describe what they are going to do and what it will feel like. Giving them more information is key to reducing stress. 

Telling them how they will feel before inserting the IV can itself reduce the pain.
When a Gastroenterologist scopes a patients, he always keeps talking and explaining the patient about how he/she is going to feel with each and every step. 

5. Learn how to empathise: The physician's interaction with the patient is a major part of the ED experience. Few words of empathy can do wonders to your interaction.

I am sorry to hear that
That must be really hard to cope up with
Now you are at the right place, we will take care of that

6. Stop being judgemental: Most of us fall for this and start judging patients based on the acuity/ chronicity of their complaint and tend to get casual with the diagnosis. I think it takes a lot of time and courage to decide when to go to the ED because of the environment in which we work. Self treatment is always the rule and when nothing works or things get really out of control, only then we go to the ED.

If they land up early, we say "All right, it is just a day of fever. Did you try some paracetamol?" 
When they come too late we ask "Why did not you come sooner?"

7. Tell them how the ED functions 
EM is still evolving in India and don't be surprised if patients are not familiar with your work process. Be upfront about the systems, if required take a minute to explain them triage and let them know we don't attend people on first come first serve basis, but the sickest is dealt with first.

8. Maintain Privacy
Patients gets to decide who is going to stay with him/her. We need to make sure that we maintain  privacy while asking personal bits of history and doing the examination. If you draw the curtains before starting the interview, it makes them feel safe and secure. Do not set your own arbitrary rules for them.

9. Educate everyone on how they can contribute
It is not only the physicians who should work towards improving the patient satisfaction, but everyone involved in the patient care. Educate each of one of them, right from the housekeeping staff to your nurses, interns, medical students. Working towards patient satisfaction is not optional, but this should be mandatory.  

10. Follow up phone call (My favourite)
This might sound a bit too much, but you will absolutely nail it if you can do this. Regardless of whatever happened during the ED visit (good or bad), if you can follow up your patients with a phone call then I guarantee you that all of them will turn back to you next time. This really goes a long way in terms of branding your ED and also building relationships.

For patients "care" of course includes not only the treatment but also the manner and social/emotional context in which treatment is given. Lower patient satisfaction means lower-quality care, regardless of the technical appropriateness of treatment and regardless of how well you do on the core measures. 

It is not how much you do, but how you do it

These were a few things that we can all try and do and make our patients feel better and more satisfied. Always make high patient satisfaction a rule and whey they are satisfied, you will be automatically satisfied.

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