Facilitating Patient Communication 

 By Laura & Janet Greenwald



We’ve all seen patients who were far beyond the reach of medical treatment suddenly defy the odds and recover.  We’ve also seen patients who were well on the road to recovery, take a turn for the worse for seemingly no reason at all.  No matter what the technology or how terrific we are at our jobs, sometimes medicine just isn’t enough. 


Case in point, a few years ago, my Grandma, in her mid-sixties at the time, had a moderate stroke.  No matter what her doctors did for her, she wasn’t regaining consciousness, defying explanation.  My mom and I were living and working in Los Angeles and Grandma was two thousand miles away in Chicago. When the doctor called to tell us about the stroke, he not only said that Grandma might not live through the night, but that she might not last the few hours it would take us to fly to her side.  Mom and I both felt very strongly that we had to talk to her for what might be the last time, before we got on the plane.  Hearing our voices and knowing that someone was with her, had always made a huge difference in any difficulty she faced.  


So Mom got the head nurse on the phone and asked if she could get a phone to Grandma.  Asking quickly turned to pleading – we needed to tell Grandma to hold on and that we were coming.  The nurse basically dismissed the notion – what possible good could THAT do?  It took a while, but Mom finally convinced the nurse to put a phone up to Grandma’s ear.  We were able to tell her how much we loved her, that she was going to be fine and that we were on our way.  By the time the nurse came back on the phone, she was speechless. Evidently the moment Grandma heard our voices her eyelids began to flutter.  Her vitals stabilized, her eyes opened for the first time since she’d been in the hospital and she looked straight up at the nurse and then around the room looking for us.  Two weeks later, she was out of the hospital and on her way to rehab.


That’s the miracle of communication.


Whether it’s a family member, a friend or just a familiar face, patients need to have the people they love surrounding them, when they’re ill, in pain, or afraid.  As caregivers, it’s part of the job to realize that patients might be too ill or physically unable to initiate the contact they so desperately need, on their own. 


I wish that were the end of the story.  A few years later, Grandma who had recovered fully, badly injured her leg and her jaw after falling in the bathroom at home.  She was unable to speak but was in stable condition, when admitted to a different hospital.  She was supposed to have gone on vacation so we hadn’t expected to hear from her and had no idea she was in the hospital.  A few days later she began spiraling into critical condition.  By the time the hospital called us, she was in the ICU, unconscious and critical.   While I was on one phone trying to get a flight, my mom was on the other phone with the doctor who happened to be standing right outside Grandma’s room.  She begged him and then the nursing staff, to get a phone into her, so she could talk to her, for what looked like it would be the last time. 


But at this hospital, the doctor and the nurses refused.  While the doctor was on the phone with mom, Grandma, who had been unconscious just a few minutes before, unexpectedly opened her eyes and began to look around.  The doctor told Mom what happened and took this as a sign that she her condition was turning around.  Even so, Mom still pleaded with him to get a phone to Grandma.  He told her there was no way to get a phone to an ICU patient.  “We’ll try and figure something out in the morning,” he said, hanging up the phone.  But Grandma didn’t have until morning.  She died just a few hours later, before we could get to her and we lost our chance to tell her we loved her – our chance to say goodbye.


Looking back on that time reminds me of that scripture, “without a vision, the people perish”. Some people, even while facing serious illness or death are so self-motivated that just the possibility of dying makes them muster every ounce of strength they have, to fight it.  But most people aren’t that way.  Most people need to use the strength of others – the people they love – to provide the strength they cannot find. 


Patients need connection.  They need vision – the vision to “see” themselves getting through the darkness and fear that they’re facing.  They need help “seeing” the next day or the next week.  Seeing themselves strong and well again.  And without that strength and that support they so desperately need from the people they love, there is no vision.  And without that vision, they perish.


Simply put, at that moment, Grandma needed us.  She needed to hear our voices that night and the very people who were there to be her advocates and to help her make that connection happen, didn’t do it.  And that night, Grandma perished, without knowing that we were right there at the other end of that phone and on our way to be with her. 


The good news is, the same thing that happened to us, doesn’t have to happen at your facility.  With just a few simple steps designed to help communication-impaired patients, you can not only make a huge difference in their lives, you might even save them.


With just a few simple steps designed to help communication-impaired patients, you can make a huge difference in their lives.


Assessing Your Patient’s Ability To Communicate


The next time you’re caring for a patient with compromised communication ability, take a moment to see your patient’s surroundings from her perspective.  If your patient’s family and friends are not at the hospital with her or can’t come often, are there tools you can provide your patient that will facilitate communication with the outside world? 


Mobility Limitations


  If your patient can speak, is the telephone close enough to her for her to use?

  Does she need help dialing?  Is she able to see well enough to read a number off a piece of paper or out of her address book?

  If your patient is unable to hold a telephone, would she benefit from a speakerphone or a cell phone? 


Hearing/Speech Limitations


If your patient can’t speak, ask her to indicate if she would like to have someone called for her, and task a patient representative or volunteer to hold the phone up to her ear and facilitate their communication.


If your patient is deaf, make sure that your facility has TTY telephones to connect with family members.   If your patient is blind, make sure that she has Braille writers or other devices to help her communicate.   


    Take a moment to call the department in your facility that deals with hearing or vision-impaired patients. They may have more tools or ideas that can bridge difficulties and enhance communication.

    Another idea for patients who can’t speak, is patient Internet access.  If your hospital has it available, it can be a real lifesaver, allowing a patient to type an email, a text message or to supervise while a message is typed for them.  If your facility doesn’t have Internet access for patients, either you or another team member can use a smart phone or cell phone to send an email or text a message for them, facilitating emergency communication with a loved one. 

     For patients who have a temporary physically impairment, like a broken jaw, encourage them to use patient Internet access or their cell or smart phones (if allowed) to email, text and keep in touch with family or children who might not be able to visit in person.


If you work with seriously ill pediatric or adult patients who need to communicate updates about their patient to a whole team of family and friends, there is a terrific service called Care Pages.  It was created by a family with a seriously ill child and no time to constantly email everyone who wanted to know how the child was doing.  Care Pages provides free web sites to families enabling them to post pictures and messages from or about the patient without the painstaking task of having to update well meaning loved ones one by one!  It gives families a way to reach out to others while spending quality time with the person who matters most – the patient.  You can find more information at www.carepages.com. 


Critical Care/End of Life


Since many hospitals still don’t have a means of patient communication in the ICU, you may have to get a bit more creative for patients in critical care units. 

There are now low emission wireless phones, like those manufactured by Spectralink, which can be used safely in critical care units.  Wireless web pads also work well, or if those aren’t available, you can always order an extension phone, like those used in regular patient rooms and keep it at the nurses’ station.  When it’s needed, it can be plugged into a phone jack in a patient’s room.     


And don’t forget that technology is making huge strides in facilitating patient communication.  As unusual as it sounds, surgeons are now using Twitter to keep families apprised of patient’s progress during surgery, while families who are apart during emergencies, are using Facebook and MySpace to keep each other up to date.  You can use that same technology to help a critically ill or dying patient communicate with family members who might not make it to the hospital in time to be with them.   


How?  With your smart phone! 


Most smart phones have the ability to record video, audio and take photos, all of which can be sent or received via email right from the phone.  Let’s say you have a patient who might not make it through the night.  His family is about to board a plane, but won’t arrive for three or four hours.  Even if you aren’t allowed to turn your personal cell phone on to receive calls in the ICU, the family can record a video or audio message on their own phone and email it to you, so you can play it for the patient – something you can do without the phone actually being on.  Or they can email you a photo of themselves to show to the patient or an email that your patient can read for himself.   


You can do the same thing at your end.  Let’s say that your patient is alert and oriented now, but you both realize that he might not live.  By using your smart or cell phone with video or audio recording capability, he can record a final message to a loved one, that can later be emailed to the family.  I don’t think I have to tell anyone, how much that bit of video can mean to a family. 

Or let’s say that your patient is a John Doe or that she was a part of a mass casualty and even though you’re relatively positive you have the right name with the right person, the family member is still in transit.  You can snap a quick photo and email it to the family, hastening the identification. 


Communication isn’t just a patient’s right – for many it can be their only link to the outside world, or a life-renewing source of strength and love.  Combine that with outstanding medical care and watch the miracles flow.   

Learning how to do facilitate patient communication is just ONE way to increase patient safety, health and satisfaction while reducing liability.  We have many more...


Notify In 7 - The Seven Steps to Successful Notification System is filled with tools you and your ED/Trauma Staff can use to facilitate NOK notification, patient identification and communication. 


Or if you want to create change throughout your entire facility, our new Six Sigma based, HIPAA-friendly, “Notify In 7 - Creating A Next of Kin Notification Program” has everything you need to roll out the Seven Steps facility-wide.  The Program includes patient tracking workflows, tools and training materials, based on Notify In 7.  It  provides your Emergency Department staff, managers and Risk Management professionals with comprehensive training, while giving you and your hospital a fully operational Next of Kin Notification System in just 90 days. 

Creating A Next of Kin Notification Program is now available on CD or as an Instant PDF Download.  All of the versions come with the Chart Pages, Patient Tracking Sheet, work flows and staff handouts, as well as the full Seven Steps System Guide.


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Laura and Janet Greenwald, are the founders of The Next of Kin Education Project and Stuf Productions.  The mother & daughter team were not only instrumental in enacting three Next of Kin Laws in California and Illinois, but created the Seven Steps to Successful Notification System, which teaches quick, easy, next of kin notification skills for trauma patients to hospitals like Dallas’ Methodist Medical Center. 


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