Linda has a problem. Mr. Merrakesh, the 83-year-old gentleman in 125A has been coughing on and off for much of her shift. He’s got a low grade temperature, and while he’s not short of breath, she’d really like to speak with the attending physician. She picked up the phone, but bit her lip as she poised her hand ready to punch the office phone number. The last time she phoned Dr. Abner, she got an earful about how she shouldn’t have called. He then berated her during her presentation of the case.
Afterward it took all the fortitude she could muster just to finish out the night. Dr. Abner’s office prefers to be notified about changes in condition by fax and has made that abundantly clear. Still, Linda is worried about Mr. Merrakesh, and knows that the responses to faxes about changes in condition have sometimes been delayed for days. Maybe she should just send the patient to the local emergency department and not have to deal with Dr. Abner at all.
Could this be happening at your LivingCenter? Are nurses afraid to phone you or one of your colleagues? Changes of condition are key moments which we all know must be addressed in a timely and appropriately thoughtful manner. While we trust the nurse’s judgment as far as deciding when to call us, we cannot ask them to make medical treatment decisions or assessments without our input.
The standard of care in skilled nursing facilities continues to evolve. Several years ago a patient in the office teased me for having a beeper. Now on-call doctors take calls directly on their cell phones. While some of our communication traffic, especially signature requests are transmitted by fax, faxes are not an appropriate way to communicate when a patient is getting sicker and needs a medical decision. Nor is it a good way to communicate where abnormal labs exist that need to be addressed within a few hours. Not everyone knows your schedule … certainly you don’t want to come in on a Monday to find a critical lab has been sitting on the fax machine printout stack since Friday afternoon.
Timely communication between LivingCenter and physician can mean the difference between hospital admission and a successful intervention in the LivingCenter. It can mean the difference between a patient in pain all night and one who gets an intervention in time to make a difference. Occasionally, it means the difference between life and death.
How easy is it to reach your office? Do you or your partners answer calls with patience and understanding, or are nurses filled with trepidation from the last conversation you had? Would it influence them to not call you in a time of need?
I know that we all want to provide quality care for our patients. I also know from experience that being on call all night for days, weeks or months can be grueling, and that late night calls where the situation is presented in a confused or disjointed manner can be a challenge. Nevertheless, we have to find an appropriate balance.
Without a culture of understanding and patience, the nursing job becomes so much harder to do, and our patients ultimately suffer. When we make it easier for nurses to call, respond to calls in a timely fashion, and empower them to be free with their opinion of the situation, we enhance patient care, patient satisfaction and staff morale. Also, it helps protect us from regulatory and liability risk. Many doctors I’ve spoken with in long-term care feel overburdened and stressed. Patients are sicker, EHR systems more cumbersome, and regulatory forces more challenging.
If you’re experiencing this to the point where it is affecting your practice, talk with your ED and DNS. They may be able to help figure out how to streamline modes of communication, find ancillary services that can help you, and incorporate some processes that might make your rounds more efficient. Let them help you.