An Unexpected Experience – Dealing with Duration

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“Are we there yet? “

“When are we going to be there?”

If you took a road trip this summer you undoubtedly heard this refrain coming from the back seat, or at least thought this yourself! This picture was taken three hours into a very long ten-hour drive home from Missouri to Minnesota this summer. The passengers were at their wits’ end in the back of the vehicle. Throughout the next seven hours, I helped them see the mileage and look for landmarks as we painstakingly progressed on our journey north.

In this series, we’ve been looking at the Unexpected Experience for patients and families in the Emergency Department. Last time we looked at some things that can be done at an organization-wide or department level to help alleviate patients’ concerns about their waiting and process. This week, we’ll look at some key tactics that can be used individually by staff and providers in your department, specifically with regard to addressing wait times.

You may already be familiar with the AIDET TM methodology: Acknowledge, Introduce, Duration, Explanation, and Thank. AIDET TM is a proven communication framework for providing patients and families the information they want and to help manage expectations. Most people who are familiar with AIDET TM say that the D or “Duration” (providing patients with estimates of time) is the one that they struggle with doing the most. Patients, however, are pleading with us to help give them some sense of how long things will take. Most caregivers say that they don’t do this because they fear that they may be wrong in their estimation. Patient & Family Advisory Councils cite a desire to have an estimation of duration and if it is wrong, they just expect to have the caregiver keep them informed!

We’ve worked with ED patients around the country and in focus groups, and in talking to them we hear consistent themes:

  • “Keep us informed”
    • “I’d like to be told approximately how long it will take and if it does change, just give me an update!”
    • “If it’s going to be a while – give us an estimate of how long, if it’s going to be longer that’s ok, just so we know what to expect and family can plan accordingly.”
  • “You sit there and wonder ‘How much longer until…’
    • “I get a bed”
    • “I can get something to eat”
    • “They remember I’m here”
    • “They know something about my lab work.”

Side note on AIDET in the ED: In the empathy and training workshops that I’ve led with Emergency Department staff, whenever the concept of AIDET comes up, 90% of the time they guess “Time” instead of “Thank” for the “T”! I love that it’s on the mind of the staff and physicians as they know that it’s on the minds of their patients and families.

It was in one of these Unexpected Experience Workshops that a physician spoke up and shared something that really helped to reframe the idea of duration. He said , “When patients are asking about time, I always try to understand what’s behind that question. They may be asking because the last bus leaves downtown at 5:45 and they want to know if they will be done in time to catch it. Or their kids are getting home from school in an hour and if the patient isn’t going to be there, they need to know so that they can make alternative arrangements. So, when I can get them to articulate those things I can help give them a better sense of whether or not they need to make alternative plans and that really helps to give them some answers.”

This physician really helped to illuminate something important, and that is that patients and families aren’t just asking because they want to be annoying or they’re frustrated with simply waiting. Sometimes they’re asking because someone is dependent on them and need them to get somewhere in time.

If there’s one thing staff and providers can do to help patients and families have a better journey in the ED, it’s to communicate to them about the duration of what’s next, what they’re waiting for, and how long things are expected to take. In the last blog we talked about the importance of standardizing your processes and this is so important to being able to communicate about the duration. So, when you know that it takes 45 minutes from the time the patient provides a urine specimen to when the doctor can see the result, that’s important to communicate.

Finally, don’t forget to utilize tools to help with communication. Whether you have high-tech electronic care boards or basic white boards in the room, use them! Talk to the patients about the plan of care and write out what the next steps are (in basic terms like meds, tests, labs, etc.). When you do so, be sure to give some timing estimations. And if you’re wrong, then make sure to keep the patients updated.

In our next blog in this Unexpected Experience series, we’ll explore some other components of communication and empathy that are also imperative to the patients’ and families’ journey.

 

Janiece Gray

Janiece Gray

I began my career as a social worker and later, with my Master of Health Administration (MHA), directed operations at Allina Health in Minnesota. I later directed patient experience at Allina. My background and experience give me strengths in approaching healthcare opportunities and challenges through a systems lens – with unique strengths, challenges and activation points. My experience is also informed by leadership roles leading performance improvement in patient-centered care and patient experience departments. Working in the client role with healthcare consulting firms inspired me to address some unmet needs in the industry, and to co-found DTA Associates. I have a Lean Six Sigma Black Belt, and find that the discipline of practice translates to healthcare work very well.

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