Health AGEnda

January 28th, 2012 § Leave a Comment

A thought provoking blog on random topics around healthcare and healthcare policy in relation to the Hartford Foundation’s focus on Elder Americans and their healthcare.  We are all going to be there someday, so we better focus on fixing things now.

http://www.jhartfound.org/blog/

 

 

Guided Conversation

January 22nd, 2012 § Leave a Comment

Spending this week starting a new program at a new hospital I found myself focusing on time management tools I have learned .  One of the most important ones we can use is what I like to call directed conversation.

Prior to approaching a patient or family with discharge planning you need to carefully plan your meeting with the patient.  You must have a goal for the meeting that best suits the patient’s needs and care plan and use this goal to plan a path of conversation for the encounter.  This goes beyond simply knowing the purpose of your meeting (e.g. Nursing home placement, etc.).

Playing through the possible conversation in your head prior to the actual encounter will increase the efficacy of the meeting and your ability to be useful in guiding the patient’s care.  It will also limit the opportunity for you to be stumped by questions from the patient and family.  It is important when dealing with patients and families to always have an acceptable answer to all of their questions.

It is also important to not let conversation stray away from the topic at hand.  The best way to do this is to limit the number of variables you allow into the conversation.  If you are talking about in patient rehab the patient’s care at home is not relevant at this time.  The Case Manager is responsible to help the family narrow their focus to what truly matters at this particular time for the patient’s care.

What makes this possible is remembering that each Case Management encounter for discharge planning must answer the same basic questions, but they do not need to be asked the same way each time.  If you personalize the conversation it makes it easier for you to keep the conversation moving in a productive manner toward your end goal.

You can accomplish this personalization prior to entering the room by discussing the family and patient with nurses and doctors who have met them so you know what you are walking into.   Just as you review the medical chart before meeting with a patient, it is important to know about them socially.

In the end what we are doing is “selling” a treatment plan to people.  In doing this we need to appear confident and have a concise plan to present to the patient and family when meeting with them.  If you are thoroughly prepared for the encounter and engage in directed conversation the discharge planning process will be much more effective and time efficient.

sterileeye.com

January 21st, 2012 § Leave a Comment

This is a very interesting blog by a medical photographer.  The pictures and stories that go with them are very interesting, informative, and touching.   Whether you are interested professionally or simply for curiosity’s sake you should check this out.

http://sterileeye.com/

Discharge Starts Upon Admission

January 11th, 2012 § Leave a Comment

Over and over I hear “discharge planning starts upon admission”.  This is a mantra that has been pounded into me since the first day of my current position.  There is nothing more true than that phrase.  Truly effective discharge planning starts from the moment the patient enters the hospital.
In order to effectively build a working relationship with a patient and their family it is important to become a part of their treatment team as early as possible.  This can be as simple as a quick introduction upon admission and providing the patient and family your contact information to reach you with questions.  Doing this plants the seed of a working relationship. 
Once you have been introduced into the patient’s care, you become more than a discharge planner to them.  You are a resource, someone they look to for answers and ideas, and not just someone who comes to usher them out of the hospital.  As a case manager it is important to establish yourself as an independent professional to the patients and families, and not just someone filling orders. 
Once you establish a place in the treatment team, you can begin to nourish a trusting relationship with the patient and family.  Simple contact throughout their stay and remaining available to them is what will build this.  The doctor is busy and can be difficult to reach, but the case manager needs to remain easily attainable to fill this void and answer questions when the doctor cannot be reached immediately.  Being available to the patient and family is reassuring and comforting to them, and makes you reassuring and comfortable for them to work with.
Throughout building a relationship you have done a majority of your work just by simply getting to know the patient and family.  Using simple conversation you can gather a history and establish a patient’s needs and wants without a formal and dry interview.  This helps them remain comfortable and allows you to appear genuinely interested in the patient and where they are from. 
This background combined with knowing their current medical needs allows for the formulation of the patient’s discharge plan.  Which at this point should be simple to present to them and move rather quickly as you have built a trusting relationship through early and frequent contact with the patient and their family.  Discharge planning is truly 90% relationship building and 10% actual service arranging.  Once you get a family to trust you, the rest of the planning is simple. 
You should become the constant figure that helps make sense of the chaos throughout the patient’s stay.  You become the beacon that helps them realize there is an exit from the hospital that is safe and attainable for them.  This is all accomplished by starting the discharge planning upon admission and remaining constantly recognizable to the patient and family throughout their stay.

Providing Options

January 2nd, 2012 § 1 Comment

One of the most important things to remember in the hospital is that patients and their families need to feel they are in control of patient care.  The last thing they remain in control of is the ability to say yes or no to procedures and continuing care options.  It is important to not take this away from them, but it is also important to guide them through their decisions while keeping them as simple as possible.
In relation to discharge plans it is important to recognize the difference between choices and options.  Giving a patient choices is walking into the room and saying,  “The doctor says you need to go to a Skilled Nursing Facility (SNF) here’s a list let me know what you pick.”  Giving options is explaining to the patient why they need a SNF, what they will do there, and letting them know a few places close to their home.  Guiding them in making the decision, and helping to make it as simple as possible.
When working this way the patient retains their right to make their own decisions, however, as they may not know which direction to go in, as they are already in a crisis situation and unhappy about losing control of their life, we are assisting them by doing most of the work for them and allowing them to simply give their approval. 
Some may say this is not an appropriate way to work with patients, and that it is taking away options from them.  Let me explain how this is better by referring back to the SNF example above.  Imagine your mother is in the hospital and has to go to a SNF.   Your mother being sick already upsets you, and you are now more upset that the doctor has said she cannot return home.  I then walk into the room after the doctor and hand you a 3 page list of SNFs around the area and ask you to choose one.  In the already fragile state you are in that kind of decision would be unmanageable. 
What you need is guidance.  You need someone to help sift through your mom’s needs and your wants and make that list more manageable.  To simplify your decision and take away days of debate and searching that only transform a tough decision into an impossible one.  It is much easier to make a decision in hours than in days.  That is a burden that you do not need at this time.  You need to be with your mother and family. 
It is always important that a patient and their family be in control of their healthcare.  It is equally important that we, as healthcare providers, realize we are the ones who can help keep them in control of an unmanageable situation by providing them with easier decisions by simplifying their options.  Providing a more manageable situation for patients and their families is a key to quality case management, as well as the best service we can offer. 

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