Physician leader and nurse leader rounding on patients and families is a foundational tactic that helps reconnect leaders to patient care and helps them understand how patients perceived their care in the emergency department.
Leader rounding on patients in the emergency department should focus on three main areas: pain, plan of care, and duration. Leaders might ask the following questions when rounding on a patient:
- How have we managed your pain today? (pain)
- It is important to me that you understand your plan of care while here in the emergency department. How have we done in keeping you informed about what is going on? (plan of care)
- What is your next step and how long did we tell you it would take? (duration)
Asking the right questions when rounding on patients equips leaders to better coach and mentor frontline staff by revealing opportunities for improvement and for reward and recognition. In fact, the most important part of leader rounding is the feedback given to staff. There is an art to how we deliver that feedback. Leaders should follow a support-coach-support approach when coaching in the ED:
- You did ____ well today. (support)
- Here is one thing I’d like you to do next time you round on your patient. (coach)
- Tell me what you are going to do differently. Thank you for the great job you are doing.(support)
Focus your effort on what will have the biggest impact when rounding on patients and when coaching staff. We recommended rounding on only a percentage of discharge patients at first. Also, particularly when coaching emergency department staff, even if you find multiple behaviors that need correction, only focus on top priority items.
Emergency department care transition calls drive stronger transitions of care and are a proven tactic to improve clinical outcomes, positively impact the patient care experience, and reduce preventable readmissions.
As with leader rounding on patients, you don't need to tackle the entire discharge population. You may consider starting by focusing on a sub-population such as those that are return visits. (Studer Group’s Patient Call ManagerTM offers a powerful tool for post-visit calls.) Also, a key component of success with post-discharge calls is to involve the whole team so that everyone is modeling the behavior and making the calls, including physicians.
The ER at Stonebridge (McKinney, TX) has demonstrated success in the ED with results in patient perception of care ranking at the 95th percentile or higher since implementing calls.
Steve M., the emergency room director at Stonebridge, shared the impact that care transition calls have had on his department. “Transition phone calls for the ED may be the single most important thing we do at The ER at Stonebridge. When you consider the overall rating of ER care by those who have received a discharge phone call it becomes more than theory, it becomes science. I think our key to success here at Stonebridge has been buy in first of all from all of the nurses who spend hours each shift on the phone making the calls. Because they are nurses they are also able to bring closure to many calls that an ancillary staff might not be able to. Combine that with the success of having stopped a suicide attempt by calling back a patient and it is no wonder they have bought in.”
The bottom line is that our patients are still our patients even after they are discharged. Connecting with patients through a post-discharge touchpoint is the best way to ensure care compliance and improve overall clinical outcomes. Not to mention, patients feel empathy for organizations when they receive a quality touch point once they are home.