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MESH Up to Enhance Patients' Experience (and Yours)

Milano, Marc, MD

doi: 10.1097/01.EEM.0000552795.72573.43

Dr. Milanois the chair of emergency medicine at Robert Wood Johnson University Hospital in Somerset, NJ.



You're on your game, providing great clinical care for an 82-year-old woman with cough, fever, and dyspnea. You arranged for admission for her pneumonia after discussing with the hospitalist. All set, right?

Not so fast.

You already moved on to the next task when the patient asks her nurse when she is going upstairs. The nurse doesn't know the plan, and responds, “Oh, you're being admitted? I had no idea.” Outcome: fail.

It could be worse. Say the hospitalist comes to see the patient and starts to discuss the treatment plan, but you haven't informed the patient that she needs to be admitted. Double fail, with the patient and the hospitalist.

Excellent bedside manner can help provide a great patient experience, and an abundance of information is available on the best practices for communicating well with patients and their families. One thing that is often overlooked, however, is the impact of provider-to-provider communication on the patient experience. Patients are extremely sensitive to inconsistencies and lapses in communication between providers, and we undermine all of our hard work in caring for them if we do not perform well as a team.

But we can win their confidence and satisfaction if we show that we are working together. Two simple ideas—MESH and 4W—can help us ensure success during these transitions.

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Manage Up: Managing up is about instilling confidence in the other providers who will care for the patient. Think of it as a way to create a positive feeling in the patient about subsequent encounters. Tell the patient about the hospitalist who will be admitting her, explaining that hospitalists only take care of patients in the hospital. You can stress that all of the hospitalist's attention will be focused on the patient, and that her goal is to make sure the patient gets the best care. You can also explain the hospitalist and her team are the only doctors that the patient's primary care physician will allow to take care of his patients in the hospital.

Expectation-Setting: Let the patient know that she will not be going upstairs immediately even though she has been admitted. Tell her that it is important to have the team and the room upstairs ready for her, and that that can take some time. Reassure the patient and family that she will get the same great care regardless of location. I like to tell them that I don't want them leaving the ED until all the work necessary for the initial care is completed to my satisfaction.

Summary: Recap the visit. Review important test results and treatment so far, and make sure the patient understands. You may ask the dreaded question: “Do you have any questions for me?” Or maybe a less daunting question like, “Does everything make sense to you so far?”

Headline: Lastly, you should script the patient on what he can tell his friends and family. I will say something like, “So when you call your daughter to tell her what's happening, this is what to say....”

Once you have meshed with the inpatient team, it is time to make sure the other caregivers in the ED are on the same page. This is especially important for our nursing colleagues. Using the 4Ws will make it easy to bring the patient's nurse fully into the transition to inpatient care. You will find that empowering the nurse with the 4Ws will save time and energy because you will receive fewer requests to return to the bedside to explain these details.

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Who: Give the patient and nurse the name of the admitting physician and ideally the inpatient nurse who will be receiving the patient (another opportunity to manage up).

Why: Provide the patient with her diagnosis and the reason staying in the hospital is necessary, such as, “The medication is only available intravenously.”

Where: Give the nursing team and the patient the hospital location, ideally with the room number, and a description of what the experience will be like there. You could say to the patient, “You are going to the neurology floor. They specialize in the care of strokes and mini-strokes, and they will be checking you frequently for any changes in your condition.”

When: Tell the patient approximately how long it will take to go upstairs and pledge to keep the patient and family posted.

These are just a few easy, immediately actionable techniques that you can start using on you next shift. The best way to provide a great patient experience is to think about how you would like to be treated as a patient.

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