One of the biggest challenges with managing communication during a hospital admission is the lack of a standard set of operating procedures across hospitals (or even units, within a given hospital). This means that whether you are physically present or not, you’ve got to first establish how the unit functions and then ask the same questions, over and over, as necessary.
I like to begin by calling the unit to which my client has been admitted and asking to speak with the primary care nurse. From there, I explain my relationship to the patient and state that I have permission to speak regarding his or her care (I produce written permission if necessary).
You could say something like this:
“Hi, I am Dianne, Mrs. Savastano’s daughter and I am her emergency contact. Thank you for taking care of my mother. I am very concerned about her so I am calling to check in and to gain some clarification about how communication flows in your organization. To start, how is she doing today?”
Regarding physician care, ask:
“Who is the physician in charge of my mom’s care? How does the physician hierarchy work on your unit? Is there a Hospitalist in charge who defines the plan of care? Are residents involved? Who is theattending physician? Who is the decision maker today and how do I contact him or her?”
Regarding nursing care, ask:
“Are you familiar with the plan of care for the day? How long will you be caring for my mom today? Who will be caring for her on the next shift? Will you be caring for her tomorrow? What is the best time to call you tomorrow morning?”
Regarding discharge, ask:
“Although my mom has just been admitted, I know that hospital stays are very short, so I’d like to plan ahead. Is there a case manager with whom I should work, so that we may plan for my mom’s discharge? Who is that and how do I get in touch? I’d like to call and introduce myself.”
Throughout it all, I ask questions and gather information, writing everything down as I go.
In addition to gathering facts, note as well that I make sure to reiterate my appreciation for all that I have learned and to say thank you – over and over again. Developing positive relationships with the physicians, nurses, administrative staff and anyone else with whom you come in contact goes a long way. I always let hospital personnel know how much I value their professionalism, experience and knowledge.
Make contact with the physician(s)
It is important to understand the physician hierarchy within the hospital in question. Are you in anacademic health center or a community hospital? Are medical students and resident physicians in training involved in the care of your loved one? Is a Hospitalist in charge? How does your loved one’s own primary care physician fit into the picture, if at all?
Answers to these questions provide critical information as you work alongside the team, and as you relay your loved one’s medical history and baseline level of functional abilities he or she had prior to admission. You’ll also want to discuss the setting to which your loved one will be returning and note resources available to assist at home.
A typical conversation may go like this:
“Hi, I’m Dianne, Mrs. Savastano’s daughter and I am her emergency contact. Thank you for taking care of my mother. Can you help me to understand your role on the physician team? Who else is on the team and how does the hierarchy work? Please describe my mom’s medical status and please note that I am unfamiliar with most medical terms so I may need further explanation, I plan to take notes, and I would like to repeat my understanding when you finish so I know I understood correctly.
“What would you like to accomplish today and what outcome are you hoping for? Are you caring for my mom throughout the night? If not, who is caring for her and how might I reach him/her? Will you be my point of contact tomorrow for a similar conversation? What time is best to speak? Let’s exchange contact information. I plan to be in touch with the case manager so that we can prepare for discharge. Do you have any prediction as to when that might be?”
Speak with the case manager
In most hospital settings, a nurse or social worker is responsible for working with the patient, the medical team and the family, to prepare for discharge. As hospital stays are managed tightly, planning must occur from day one.
Although it might not be relayed to you right away, I assure you that everyone inside the hospital is planning for discharge, so start talking about it immediately. Call the case manager and say the following:
“Hi, I am Dianne, Mrs. Savastano’s daughter and I am her emergency contact. Thank you for being part of my mother’s team. I’m calling to introduce myself early on as I would like to work closely with you surrounding planning for my mom’s discharge. I spoke to the physician and asked if there was any prediction about a discharge date. Do you have any information surrounding discharge?
“Have you met my mother yet? I’d like to relay as much information as possible about the setting my mom was in and where I hope she can return to, is now the best time? If alternative settings such as short term rehabilitation are being considered, I’d like to visit the facilities and make the best selection for my mom. Can you help me with that? What about in-home care, can you help me to understand how that works?”
Stay connected along the way
If you are able to physically be with your loved one in the hospital, pay attention to all that goes on, be assertive and don’t be afraid to ask questions. Taking a notebook along with you and keeping track of conversations and events will allow you to accurately recall your understanding of things and reaffirm plans.
If you are not able to be physically present, don’t be afraid to make the same phone calls day after day. Hopefully, by the second day of an admission, you will have a nursing and a physician contact. (Be prepared, however, to start from scratch, as staffing is always subject to change.)
Overall, the key is to have someone (in addition to the patient) manage the process and communicate on his or her behalf. Until it becomes standard practice for hospital-based physicians and nurses to pro-actively call a patient’s selected family member/care partner, be prepared to be politely assertive and to spend quite a bit of time patiently waiting for in-person and/or telephone communication.
Your involvement will be key to a successful outcome and discharge.