Authors (including presenting author) :
Lui BKP(1),Li PY(1),Ho SKS(1),Cheng W(1),Mo YTM (1),Mak PKF(1),Kng PLC(1)
Affiliation :
(1)Department of Medicine & Geriatrics, Ruttonjee and Tang Shiu Kin
Hospitals
Introduction :
Current ward communication practice when patient’s relatives request to see doctor for patients’ condition is through verbal message from nurse to case doctor or written messages on an informal note. Such unsystematic and unclear message leads to misunderstanding among healthcare team, giving rise to relatives’ complaints because of delay or miscommunication.
Objectives :
This is an improvement initiative to enable timely response to carers’ request by implementing systematic accountable communication among the interdisciplinary team in a geriatric ward as part of the elder –friendly approach.
Methodology :
The intervention steps involved engaging frontline doctors and nurses in designing a communication system, with a doctor-individualised ‘Interview Request Form’ which includes patient’s personal particulars, the request time, contact person, reasons for the interview filled in by nurses when relatives / carers request to see case doctor. Doctors sign with date acknowledgement. Team Nurse/ Shift-in-charge will check the form daily and remind doctors. The system was implemented in all 5 geriatric wards and a random compliance check was conducted retrospectively by checking case notes.
Result & Outcome :
Compliance check involved 236 records with the following; 144(61% ) showed doctor had signed the form, 208 (88%) had stated the reasons to see doctors were stated which included 84.6% asking for condition; 3.4% for feeding problem; 1.4% for medication problem; 6.3% for investigation results and 4.3% for discharge planning. To improve the compliance, further engagement to improve acceptance by doctors was via questionnaire to 13 frontline doctors working in Geriatric Wards in July, 2018. The return rate was 100% and favorable feedback by doctors that Interview Request Form assisted in providing concise & clear reminder to contact/ see the relatives (84%), adequacy of information (77%). It scored less well for facilitated family-nurse-doctor communication (46%) and helping to shorten delay between interview request and interview completion (38%). Doctors opined that ‘red alerts’ for urgency and complexity should be indicated such as potential complaint cases, family conflicts, social issues, guardianship order and repeated number of requests and earlier involvement of allied health, or activation of family case conference which may help alleviate doctors bottleneck to respond due to workload. This intervention improved the family-nurse-doctor communication in systematic and orderly manner. Although it cannot solve the bottleneck of doctors’ workload in responding timely to all requests, it provides an effective triage ‘red alert’ for urgency and complexity. In addition, it enables a wider multidisciplinary team involvement to address the multiple facets of relatives’ queries in order to respond in timely manner.
