The Hospice Tools blog provides valuable insights by our in-house hospice & palliative professionals.
The education topic for this edition covers the following CAHPS Survey question:
How often did you get the help you needed from the hospice team during evenings, weekends, or holidays?
The options are:
The answer you want to get is ALWAYS. Other answers do not count toward a good score.
THE NATIONAL AVERAGE FOR THIS QUESTION BEING ANSWERED “ALWAYS” is: 78%
Tips to improve
1. Manage expectations as it relates to on-call service/process.
But setting realistic expectations is often not about managing unrealistic patient/family/caregiver expectations . When we talk about setting realistic expectations what usually follows is a list of what can’t be done, a list of limitations.
This list is too often reflective of:
A – Agency resources
B – Dialing back unqualified marketing messaging regarding availability of 24/7 care
The standard tips for managing expectations of after-hours care are points such as:
- Make sure patients know that after-hours calls are answered by a service
- Remind patients that not every call warrants a visit
- Remind patients that even if a call does require a visit, it may take a while as the triage nurse might be with another patient or further away without the full staff availability for coverage.
These are important tips but what these tips have in common is that they highlight the agency’s lack of resources and put the blame for lack of timely care on patient or family unrealistic expectations.
Proactive tips for managing expectations:
- Build your after-hours process with a focus respect & empathy while recognizing and working within your own limitations rather than a focus on your own limitations and how to set expectations within those.
- Remember, no one is calling after hours, on weekends or holidays because it’s fun for them. The issue may not be as urgent to a clinician as it is to the patient/family/caregiver, but it is urgent to them!
- If possible, arrange a script for your after-hours answering service: A few organized bullet points will show the caller your team is professional and are being heard. A script that gathers relevant information and arranges for a quick call back by a clinician can go a long way towards alleviating the caller’s anxiety.
Hello, this is ‘Your agency’ Answering Service, how can I help you?
<Repeat> Can you tell me (again) what is the problem?
OK, thank you. I will have the triage nurse call you shortly.
What is the Best Phone Number for the triage nurse to call you back at?
Is there a Second Phone Number or other contact?
Thank you for the information. The triage nurse will call you back shortly.
- Call your on-call answering service and test how they answer the phone and what sorts of responses they provide.
When pressed by an anxious and frustrated patient or family member, does your answering service respond with something like: ‘We’re just an answering service, I’ll send a message, but if you can’t wait you can call 911’
Do they respond more thoughtfully, like: ‘I’m not a clinician but I understand this is urgent and will reach out to the triage nurse immediately.”
- Create an internal process to review timelines: when a message is received by the service and how long it takes to be received by the triage nurse and when the call back is made to the initial caller.
2. Exceed Expectations
Resources are limited. Create processes that allow you to maximize your agencies resources.
- Call back within 5 minutes.
- If you are with a patient, do not wait until your visit is complete and you’re back in your car. As soon as the patient is stabilized, excuse yourself and return the call. That is by definition, how triage works.
- If it is not possible to return a call within 5 minutes, have a process in place for someone else to call back. Example: A code number that can be texted that signifies you are unavailable that goes to an alternate on-call nurse or to the answering service to inform caller that you are with a patient and will call shortly.
If the nurse must go see a patient on-call:
- Provide an ETA
- If the ETA is greater than 20 minutes, call back at the 15 min. mark. This will let them know you’re actually on the way and how much longer it will be. It will also provide a sense of greater concern. This in-route call will also allow time to calm the patient/family while gathering more information regarding the situation so treatment can begin the moment you arrive.
- If you will be later than expected, call and let them know why and when you will be there.
- This goes for scheduled weekend visits as well. Provide a timeframe that they can expect you (with the notice that your schedule may change depending on emergency visits) and call them if you will not be there within that timeframe.
- Get there as soon as you possibly can.
- When a death occurs, advise families/caregivers that a chaplain or social worker may be the ones dispatched (not necessarily a nurse- unless they live in a county where a nurse must verify death). Assure the family/caregivers of the chaplain’s / social worker’s expertise and experience.
3. Provide teaching planning for a decline so when the situation turns the family isn’t in panic mode
- If your agency provides comfort kits, Nurses, make sure to instruct on the comfort kit usage at the start of care, and repeat information during regular visits.
- Anticipate symptoms and instruct on appropriate interventions.
- Provide handouts and other reading/informational material during regular visits to reinforce key pieces of information to lessen the panic when there is a decline or death.
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