On any given day, a significant percentage of hospitalized patients are there as a result of unplanned admissions, creating psychological stress and uncertainty for both the patient and their family. Although this fact may seem obvious, it holds great significance in the patient experience.
Caregivers forget just how disruptive an unplanned admission is for the patient. The patients often have jobs, children, and/or aging parents to care for, social plans, pets, and other responsibilities that fill their daily lives to capacity. Then – BAM! A hospital admission brings everything to a screeching halt.
Over the past several months, I have had numerous opportunities to do shadow coaching with hospitalists and nurses. With the big push to improve empathy, I’m surprised to observe how often providers fail to acknowledge how disruptive an unplanned admission is in a patient’s life.
A couple of weeks ago, I was rounding with a hospitalist admitting a woman for severe abdominal pain. For the most part, the physician did a great job of showing empathy and respect. And, although his communication skills were excellent, he missed one important cue.
This woman was in her thirties and, as part of her history, reported having had two C-sections. I watched carefully for cues as the physician methodically noted her surgical history. I watched the level of anxiety on the woman’s face. The physician missed the nonverbal cue.
When we stepped out of the room, I complimented the doctor on the things he did well. Then I asked, “What about her history, and this unplanned admission, could be contributing to her anxiety?” He looked baffled. I said, “Think about the fact that she has had two C-sections.” He was quick to tell me that he didn’t think the current abdominal pain was related. I pointed out that it wasn’t the surgical implication, but rather, her role as a mother, that was significant. The dates of the C-sections implied she very likely had small children at home. What stress is this emergent admission creating for her? Does she have support at home with childcare? He looked dumbfounded and said, “I would never have thought to ask about that.”
When my daughters were two, four, and seven, I had an accident that resulted in a week-long hospital stay. As a working mother, my days were planned down to 30-minute increments with school, daycare, lunches, lessons, homework, and piano, not to mention my professional responsibilities. My greatest stress was not my physical injuries, but how I would care for my children.
Unplanned admissions are disruptive on so many levels. To provide the ultimate patient experience, we must understand the disruption. Then we lend support. When patients stress, they don’t rest or heal well. Find out what stress they have as a result of unforeseen admissions. Showing sensitivity and understanding goes a long way in demonstrating empathy for their situation.