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Patient Experience

Justin Bright , MD and Rob Orman, MD
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14:26
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Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN
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02:43

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EM:RAP 2017 June Written Summary 647 KB - PDF

Every touchpoint through the ED affects a patient's experience.

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Stuart G. -

Hello,

I just listened to the segment on patient experience, and I am interested in gaining more information about how to get more involved in this area. Besides what was described on the website, do you have any additional resources that would be beneficial to learn from in order to improve the patient experience in the emergency department? Thank you for your help.

Sincerely,
Stuart Greene

Ben S. -

Great stuff in this segment! However, as with other segments over recent years (I'm thinking of a couple that pertained to burnout and physician wellness,) I felt kind of frustrated in the end. In a system defined by RVUs and patients-per-hour, it seems to me that these sorts of ideas are doomed to failure - or at least difficult to extend beyond window-dressing. The interventions described take time, something that is not (in my experience) valued in our practice models.

I wonder sometimes whether the economic model that underpins emergency practice is increasingly flawed, especially as the expectations of patients (and of health systems) change; as the patient population becomes ever more complex; as the social challenges we face (opioids, mental health) continue to increase; as the pressures to avoid expensive admissions mount; and as the high burnout within emergency medicine becomes more clear all the time. Practicing such an essential profession in a system whose economic incentives tilt against the very kind of care we are taught to provide creates a moral hazard, which I think contributes mightily to burnout, poor care, compassion fatigue, and attrition.

Do we need to rethink our economic model? Are there measures of patient complexity that could help us to better characterize what we do? Are their alternative methods of staffing? Of tracking ED value? Should we work as much as we do? Is it safe to see as many patients as we do? I'd be curious to know if there are any experts out there who have thoughts on this stuff.

Robert A. -

I am a MS4 from Chicago Medical School and an aspiring ER doc. I listened to this after a shift with a difficult patient. She was with us for about 11 hours with an extensive work up. She was difficult both her symptomatology and her personality. Her headache felt like "a headache" and asking her more detail got wails how could I be a doctor and not know what her headache felt like. Despite being freezing and requiring several blankets, the ice water was disgusting and hot. ...Etc.

Maybe it was because our ed wasn't terribly busy, but I still thought I could win her over--deciding nothing she could do would break me from being a compassionate future physician. I still took care of other patients making sure to be fair with my time. After discharge and after writing what all of her new medications were for, she uttered one glorious "thank you" as exited. So I didn't win her over but that slight gratitude.🙌

On my way home I listened to this episode with Dr. Bright and I felt my mild compassion fatigue was validated and echoed as worthwhile. I'd love to be a part of a team like the one he is trying to create and wanted to reach out to thank him for his contribution if I could.

Also, any advice for creating change in the culture from the bottom of the totem pole (MS4, intern)?

Thanks so much for what you're doing with em:rap it's awesome!

Best,
Rob
Robert.adrian@my.rfums.org

Stephanie V. -

Thanks for posting this segment with Justin Bright. I'm a full-time academic emerg doc in Calgary, Canada. We have enlisted the help of information designers with a speciality in "wayfinding" and "navigation" to help us address, what surveys in our community have identified as our biggest barrier to a positive patient experience - ED doc and nursing communication with patients. I'd like to share a project that I learned about while spending some time in the UK that evaluated aggression and violence towards staff pre- and post- intervention (intervention involved simple directions and communications with patients who presented to an A&E - UK equivalent of an ED). The consultant group found decreased aggression and violence towards staff and more satisfied patients. Just another example of how we can draw on the expertise of colleagues outside of medicine to learn how to improve the patient experience in busy, high stress environments. http://www.abetteraande.com/
https://vimeo.com/97816044

Editors note:
The posted video links are to PearsonLloyd, a private design consulting firm, and the Design Council. EMRAP has no affiliation to either of these groups

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Don’t Fear The Stink! Full episode audio for MD edition 245:23 min - 342 MB - M4AEM:RAP 2017 June Canadian Edition Canadian 24:49 min - 34 MB - MP3EM:RAP 2017 June German Edition Deutsche 68:28 min - 94 MB - MP3EM:RAP 2017 June French Français 29:35 min - 41 MB - MP3EMRAP 2017 June Resumen Español Español 94:49 min - 130 MB - MP3EM:RAP 2017 June Board Review Answers 187 KB - PDFEM:RAP 2017 June Board Review Questions 170 KB - PDFEM:RAP 2017 June MP3 328 MB - ZIPEM:RAP 2017 June Written Summary 647 KB - PDF

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