It’s the Little Things: How Patient Care Advocates Are Transforming One ED

Published December 14, 2016

In a busy ED, no matter how well intentioned the providers are, patients can end up feeling like their needs aren’t being fully met. Unsatisfied with the patient feedback they were getting despite their best efforts, one ED set out to improve the patient experience by creating an entirely new job title: patient care advocate.

Providing a Human Touch

At Via Christi Hospital St. Francis, a Level I Trauma Center in Wichita, Kan., some patients were leaving the ED with less than rosy feelings. Or at least that’s what satisfaction surveys suggested.
It wasn’t that their medical needs weren’t being addressed. Rather, there was a disconnect between patients’ expectations of care and those of the providers. 
Such a disconnect is far from uncommon. While ED physicians and staff are by definition focused on ensuring patients’ immediate medical safety, patients themselves are often looking for communication, reassurance, and comfort.
Low patient satisfaction scores can have big consequences for the hospital. They negatively impact not only referrals and reimbursements but also ED staff morale.
But even more important, the Via Christi Hospital St. Francis team felt that satisfying patients was, well, the right thing to do. They wanted the patients to feel like friends and family.
So CEP America Medical Director Howard Chang, MD, asked the ED team to come up with a patient satisfaction initiative that could be funded by a CEP innovation grant. (These awards support new and exciting projects undertaken by CEP providers and their hospital clients.)
Daniel Baker, DO, suggested creating a new role dedicated to giving ED patients care and attention that went beyond urgent medical need. They dubbed the job “Emergency Department Patient Care Advocate.”
“It’s just getting patients the kind of one-on-one time that they’re expecting when they walk in the door,” says Baker, who is also the hospital’s Director of Patient Experience.
That can mean finding the patient an extra blanket, for example, or getting them a cup of coffee. Or simply communicating the patient’s level of anxiety or concern to the attending nurse or physician so they can step in and offer support.
In other words, the little things. But those little things that patient advocates are being tasked with can — and are already proving to — make a world of difference.

A Day in the Life of a Patient Care Advocate

Angela de Souza was the first patient advocate Baker and his team brought on-board. Already a fixture in the ED after years of volunteering at the hospital, DeSouza was recommended by the department’s charge nurse as being an especially good fit for the role. She started the position, which includes a 10-hour shift during the ED’s busiest hours, in July 2016.
From day one, de Souza’s empathy spread reassurance and comfort through the department. “We see a wide range of people, and my job is to help any way I can,” she says. “Sometimes it really is a matter of bringing a warm blanket or being there to talk to a patient. I’ve had several patients ask if they can borrow a phone to call one of their family members.”
De Souza quickly learned that simply communicating to patients what’s happening and what will happen next is often all that’s needed to turn a negative experience into a positive one. In her words:

I had one lady who came in, and she had no family with her. She was just sitting there crying in her room, so worried. She had no clue what was going on, and she was relatively young, so I was able to sit and talk with her until her mother arrived.
I told her: “Okay, now we’ve seen your nurse, and your doctor’s going to come in. He’ll order some imaging, and once the radiologist reads it in an hour or so, he’ll come back and talk to you.” She was just so grateful. She felt way more comfortable knowing the routine — but also having someone to talk to.
Some people just need that emotional support — letting them know that we’re there for them, and that we’re going to try our best to take good care of them.

DeSouza’s knack for connecting with patients has also proven handy when it comes to assessing their discharge needs.
“Angela is instrumental in identifying early on which patients might benefit from meeting with a social worker,” Baker says. “We can start arranging those services right away rather than waiting until the end of the visit. It actually helps our throughput.”
Indeed, the department’s social worker, nurse manager, and charge nurses are giving the patient advocate role rave reviews. Because for them, too, it’s the little things — like having a few extra minutes to administer medication or insert an IV — that make all the difference.
And the patient advocate role is getting more than just anecdotal accolades.
Chang reports that patient satisfaction scores have increased since the advocates started making the rounds. (In fact, when they found themselves with an open advocate position a few months ago, scores hiccupped. They rebounded when the position was filled.)
With CMS moving to implement an emergency department-specific survey for patient satisfaction that will be tied to reimbursement, the creation of a patient advocate role couldn’t be better timed.

The Ideal Advocate

The patient advocate program at Via Christi Hospital St. Francis is still in a pilot phase. The ultimate goal, however, is to make it a permanent position for at least one shift a day at at least two Via Christi hospital campuses, if not more.
In the meantime, Chang and Baker say the biggest challenge when it comes to implementing the program is finding the right person for the job. They've been drawing largely from the ED’s pool of scribes, but are also actively seeking candidates in the community.
The role is an excellent fit for young people with an interest in healthcare and ideally with some work or volunteer experience in a hospital.
Temperament is even more important: an advocate should be genuinely interested in and motivated to address the needs of patients, and should have a warm, friendly, approachable personality.
It’s a big job to fill. But when the right person is found to take care of the little things, it can make everyone’s day in the ED — be they patient or provider — a little easier.

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