Paper Chase 5: Patient Satisfaction and the Telephone

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Sean G., M.D. -

Nice idea but certainly not practical for anyone doing more then one shift a week. I see avg 30 patients in a 12 hour night shift. The "two minutes" quoted as the time invested in the call is a bit optimistic to say the least. I think it would take two minutes if the person I was calling was actually available. >90% off all my personal phone calls reach a voice mail, as I am sure most here have found in their own lives. If I luck out and get a hold of the person AND everything has gone well, its a two minute call. What about the extremely likely scenario that the OB office scheduled their follow up for next week not the two days I was looking I have more leg work to undergo, because of course I will promise the person I will remedy the situation, which will entail me calling the consultant, then u will have to access the chart and document your conversation and your new recommendations. I easily can envision the time invested in each call extending to at least 10 minutes per patient. Any call that discusses any sig follow up issues deserves a notation in the chart. Then of course there is the time to gather all the pt data, so u can make the call and have an intelligent conversation. If there happens to be a shift in between the actual follow up this will get even more confusing. I would guess attempting this would entail at least 10 x 30 or an average of 300 minutes to accomplish or 5 hours for each of my shifts. I work 3-4 12 hour shifts a week, meaning best case scenario I would be spending at least 5 hours on every "off day" doing phone follow up. I did not go into EM so that I could live my job. Quite the opposite I went into EMED so I could have a life outside of work. If I wanted to work 7 days a week I would have gone into CT Surgery. Nice idea, but not realistic. I could see making a list of the few patients I see in a shift that I d/c that I have any concern about and calling them, that might be practical, but following up every case is pie in the sky.

Silver Surfer -

The actual time to send a secure message after a visit is only a few seconds (or less) per patient if you have an automation set up. It's best to send the messages shortly after discharge since some patients will have questions they forgot to ask during their visits. The concept of maintaning contact and some level of responsibility for the patient after discharge is a real game changer for our specialty. It's not going away, and in fact it will gain prevalence quickly because of increased competition between health care groups, and because of improving technology, especially video, in communicating with our patients.

Sean G., M.D. -

@Silver Surfer....sending a secure message? What are you referring to? The concept discussed here was making phone contact with patients following dc. It was clearly stated email contact or other such contact, presumably text message or similar was inferior, as common sense would dictate. My point that it is more then optimistic to believe contacting a patient to discuss how they are doing since d/c taking two minutes per patient I stand by. A few seconds(or less)? Give me a break. The vast majority of my social phone contacts result in a voice mail, in other words repeated attempts are likely to have a real time discussion, the only type of phone follow up to likely have an impact.When you factor in charting on attempts made and content of discussion, which would be the only medico legally sound way of doing this....a few seconds or less? C'mon man! You know what impacts patient satisfaction better then some high tech video/social media crap? TALK to your patient yourself in real time to explain what their evaluation and diagnosis mean and what their discharge instructions are. Only in America would we try to convert an Emergency Medicine practice into primary care. This is one of the many reasons our healthcare costs are unsustainable. A third of my patients already consider me or one of my partners "Their Doctor" and often can not even name their actual primary care doctor. The concept of educating our patients to be responsible users of the medical system would be a real game changer as well. One that might actually mean our grandchildren can also expect to get decent medical care.

Silver Surfer -

@sean... In our group, physicians can either make a follow up phone call or send a secure message (encrypted, web-based email) to our patients. All of our docs prefer secure messaging since it's so fast. The secure messaging boosts our patient satisfaction scores equal to that of phone calls. And our younger patients overwhelmingly prefer secure messaging to phone calls. I can understand the scepticism of someone who hasn't tried this. And you bring up an important points about cost and emergency medicine encroaching upon primary care. One of the surprising outcomes of secure messaging is that the vast majority of replies we get are expressions of gratitude for the care provided.

Michael U. -

As an ED physician assistant, I have been in charge of our "follow-up office" for the past four years. This "follow-up office" requires a practitioner to call back 80-100% of discharged patients from the previous day. We are incentivized to complete this. I can give you a personal testimony that this is the single most important thing a practitioner can do In his or her day. Not only have we seen dramatic improvements in patient satisfaction, But we are able to give positive feedback to staff members ranging from housekeeping to nurses to practitioners boosting morale in an otherwise stressful environment. Presumptively, this action also decreases patient complaints, reassures patients, and ensures that patients are complying with recommendations including taking their meds and following up. Phone calls typically last 2 to 5 minutes And can be done during charting and infrequent downtime during the day. If anyone is spending more than five minutes on the phone with a patient, he or she simply have not developed the art of callbacks. Numerous tactics can be developed in order to get you off of a phone call.
Put simply, callbacks I just a great thing all around.

Michael U. -

By the way, prior commentary seems to indicate that leaving a message is inferior to speaking with a patient. To certain extent, this is correct. However, leaving a message still has a positive impact whether or not that patient decides to call you back. I always leave my name and direct contact number in the ED on messages and, surprisingly, I receive a good share of those calls back.
I too am a skeptic of secure messaging. Voice to voice contact has already been proven to be successful and Seems more genuine than messaging.

Sean G., M.D. -

@Silver Surfer, I can see that working, and sending a secure message as u describe would certainly take only a few secs as u stated. The only issue I have with that is Sanjay and Mike seemed to suggest that this form of communication did not compare with the actual phone follow up. If your experience is that patient satisfaction was sig increased by this I think that is great, and that is something I could get behind, because as it leaves its own evidence trail I do not think it would be tedious, one could simply look up the emails/texts and see what was communicated if one needed to (ie your defense attorney God forbid). So what u are saying seems to contradict the authors here, and if your experience turns out to be fairly universal that really will be a game changer. I would like to see a response to u here from Sanjay or Mike, because as I stated I can't really see anything more than the type of follow up u are suggesting being realistic. Thanks for the tips. I am going to run this by our group. If it works I promise you I will pass along some of the two dollar wooden coins (useable only in our hospital caf) that our Admin so generously doles out to docs that get compliments from ED patients...(-;

Sanjay A. -

Hello all. Sanjay and Mike here. Fascinating to read how much interest and conversation this topic has sparked. The bottom line as we see it is as follows: Patient satisfaction is important - and contacting patients post-discharge may be an effective way to move the needle. Now the best method of doing this is highly dependent on your practice, and patient population. The optimal stategy will likely be subject to trial and error in your group. Calling every patient is clearly unreasonable. But maybe calling 1-2 people per shift is a feasible goal. Although limited, available literature suggests automated methods of communication such as texting and email are just about as effective as a call, and are far easier. However, they just have some up front costs to set up. We don't want to be PMDs, but extending care can provide us personal feedback and enhance the patient experience. While spending more time with this patient during their visit is clearly a great strategy, there is plenty of evidence that suggests patients don't always hear what you are saying when they are sick, in pain, and often medicated in the ED. Post discharge contact (by any method) offers an opportunity to emphasize and reinforce key follow-up instructions. This is certainly not meant to be a mandate - you need to figure out how this can fit (if at all) into your practice. As technology progresses, it may be easier to implement.

Sean G., M.D. -

@Sanjay and Mike, sorry but you guys said "email really didn't work as well" and of course calling SOME patients for follow up would be doable and at times awesome, but it wouldn't be effective in changing overall satisfaction if 10% of patients are called. I hear what Silver Surfer is saying and I think the text/email thing actually makes great sense. I am sorry if I misinterpreted your meaning, but the statement "email didn't really work as well" led me to believe email didn't really work as well.....

Stephanie S. -

In our group, the physicians call 2-3 patients per shift. Our hospital also has nursing staff do patient callbacks. Our goal is to capture 100% of discharged patients.

I call higher risk patients (elderly abdominal pain, head injuries, etc) and leave the more mundane for nursing call backs. It's a positive start to my shift each day because the patients are so appreciative of the fact that you cared enough to call and check on them. I initially dreaded making the calls but I've really come to look forward to them.

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