- Hasan Abid, MD
It’s easy to see how patients become confused and dissatisfied in a busy health care environment. Providers of all backgrounds come in and out of the room, many of whom the patient has never met. With specialists, technicians, and nursing shift changes, it can be hard sometimes for patients to even know who their doctor is, let alone how to find them. Multiple risks to patient safety may lie in this scenario; trust, adherence, follow-through, and patient engagement are all on the line.
Dr. Hasan Abid thinks a lot of this can be cleaned up and made safer with a simple card that a physician hands to a patient when they first meet. Dr. Abid is an internist and a graduate of Harvard Medical School’s Mastering Quality and Patient Safety Program, as well as a Fellow at the Institute for Healthcare Improvement. He helped lead an intervention project at Massachusetts General Hospital with the information cards. And the result was a much more satisfied patient study group about communication with their providers.
Dr. Abid joins us now to talk about how the project succeeded at his institution, and how it might work elsewhere.
Q.) Dr. Abid, thank you for joining us.
A.) My pleasure.
Q.) Why did you become interested in this kind of an initiative and then once you did, how did you figure out what you were going to do?
A.) Yeah, I would really speak about the personal story for myself why, which really prompted me to take this kind of initiative. A few years ago, I had experienced the health care system firsthand. I have been a physician caregiver of a family member who actually suffered a medical error leading to wrong diagnosis and harm due to adverse trouble reaction as a result of an inappropriate medical treatment. My family member was lucky to recover from this, but reflecting on that incident, I would want to tell that I started applying the systems lens. And I could easily figure out that how ineffective communication between a doctor and a patient could lead to medical errors, patient harm, and lack of trust on the system, which ultimately reflects on getting the poor experience of the care.
Q.) And one of the things you had to do once you decided that this was an area that you were working on was to say, well, then, where do we start? What's a technique or an intervention that we could try and see if this improves things? How did you decide that you were going to focus on these cards?
A.) We have seen that communication failures can occur between patients, family, and health care providers, as well as among the health care provider themselves. And no setting in the current health care world is immune to these kind of hurts or these kind of communication failures. They can occur in ambulatory setting. They can occur in the inpatient setting and they can also occur in the emergency care setting. And this really contributes to the lapses of processing the electronic health care record data accurately, failure to reaching consensus on the treatment plans for the patient and definitive discharge and follow-up instructions sometimes when the patients are leaving from the inpatient settings back home. And all these are areas which provide an open window for harm to pass through different layers that we have within our health care system and reach to the patient.
Q.) And these cards, they have the physician’s contact information, their hours typically when they’re rounding, that kind of information for the patient?
A.) Yes, you’re right. These actually, these cards actually had the names of the physician, a way for them, instructions for the patients to how to contact their physician while they’re in the hospital. And at the same time, what to expect when the roundings will be, when the physicians will be rounding the patients. Kind of set some expectations around their process of daily care. And what about the treatment and then different kind of person, what role will the primary attending will be playing in patient’s care while they’re present in the hospital. All this information is present in these cards when they were being handed out to the patient.
Q.) Let’s talk a little bit about results then. Maybe you can tell us what your initial findings are?
A) What we saw was an overall improvement in different measures, pre and post roll-out of these cards from a sample of more than 500 patients. And we found that patients were more likely to identify the primary attending responsible for their care after we rolled out these cards. And they were better able to understand the role of their attending in coordinating the various aspects of diagnosis and treatment during their stay in the hospital. At the same time, we also found that the patients were much better informed and aware about how to reach out to these providers in case that they had some concerns or they had some new symptoms. Sometimes you start medications and certain treatments and the first person to actually recognize that particular adverse reaction or adverse symptom is the patient itself. And if they in a timely manner could reach out to the physician while or reach out to the staff for help in a timely manner, we could prevent that adverse event sometimes. And this really highlights that, that they were much better and much more aware in terms of how to reach out to the physician if they had any concern.
Q.) What would you change after this pilot? You learned things and there were some challenges along the way. What would you do differently or what do you want to sort of adjust based on what you’ve learned from this experience?
A.) What we try to target during this project and this initial work was to standardize a way to at least streamline that initial communication between the patients and the physicians. And the next thing, which would be much more challenging and something to look for, would be to standardize it for all different kinds of patients that you have, whether it be patients with different kinds of language barriers, whether it be patients who have speech difficulties, patients with other deficits as well which impair their hearing and listening, but all of them do still have some kind of communication needs and expectation.
Q.) And how about the rest of the staff. Was there more reaching out by patients who had these cards, and did that impact the workload of the staff?
A.) Our staff in the hospital were already receiving calls and different kind of services for the patient, when the patients were concerned and all that. But it turns out that patients, when you look at the patients themselves, a majority of them were unaware of how to contact the doctors or how to reach out to the staff if they have any concern. They may know that they have to press the bell and call the nurse or call the staff for their help. But at the same time, these technologies, we only expect from our side as physicians that patients would know this. If we look at, do the patients really know all these things, we were surprised to see that in our pre-data collection phase, we found out most of the patients didn’t. What it really impacted was it’s kind of improved patients own understanding of the care processes that happen within the hospital. And as a result of it, they were better aware of what’s going on. And that helped us out. Some of the times we did heard about certain patients during this time who had some more needs and extra help was required and maybe they were concerned about certain symptoms or new symptoms more often than other patients were not. But it did not really impact at a greater level what was the workload of our staff.
Q.) This has worked in the units that you’ve tried it in. Do you recommend this for any kind of handoff in any kind of a setting?
A.) Well, we see that communication failure is a contributing factor to not only the safety of patient care but also to the quality of care they receive and experience with their care and satisfaction with the care that the patients are receiving in any setting. And if these standardized scripted cards are used as they were used in our setting, doctors will have more streamlined communication. A way of communicating during their initial encounter with the patients. And will be able to provide basic, essential information on daily care processes to their patients which we understand and think that patients may know about. But in reality patients might not know about all these things. And these are the small things that really affect patient safety and also at the same time enhance patient experience.
Q,.) Terrific and it’s just so important and this looks so promising. Thank you.
A.) Thank you.
Q.) Dr. Hasan Abid is a fellow at the Institute for Health Care Improvement, and a Quality and Patient Safety Physician Specialist at Houston Methodist Hospital. I’m Tom Augello.
About the series
Even in the safest healthcare setting, things can go wrong. For more than 40 years, CRICO has analyzed MPL cases from the Harvard medical community. Join our experts as they unpack what occurred and the lessons learned for safer patient care from the causes of these errors.