In The ED: How To Create An Intake Experience

This is a featured Emergency Medicine coaching tip by Stefanie Simmons, MD.

When a patient arrives at the Emergency Department, it is often the worst day of their life and they’re coming from an environment that represents the challenges they’re bringing with them to the ED. 

If we don’t take a moment to understand and become curious about them, and the circumstances surrounding their care, we can miss an important part of the clinical and connection picture. Let’s dive deeper into this.

Imagine that your house burned down a week ago. You are living in the one motel room available. You had to buy a new pair of scrubs to make your shift and borrow your colleague’s white coat and stethoscope. You have no clothes and you have no home. 

Now you must do your work having just experienced these overwhelming circumstances and burdens. Imagine carrying these burdens and circumstances into your clinical shift…but nobody you work with you knows. 

Would it help you and your colleagues if they knew? This same principle is a key part of caring for the patients as they enter our Emergency Department. Everyone has a story, and finding it is important for patients, and for us. 

Often, the only people who have had the chance to see and understand the context of the patient’s circumstances are the paramedics. If we don’t capture the patient story, we lose the opportunity to understand the context of their presentation. I often coach physicians: “Imagine what it’s like to be them…and act accordingly.” It’s a solid principle for every member of the care team. Acknowledging and responding to a patient’s circumstances as they come is empathy, the simple recognition of a patient’s struggle. 

Providing care in the ED without knowing, understanding, or being curious about what the patient went through can have profound implications on whether patients feel like we care about them. That process starts at intake. 

Here are three changes the care team can apply to improve care coordination.

  1. When a patient arrives by ambulance, the physician and  nurse and who will be caring for the new patient should meet the paramedics at the patient’s bedside and listen together to their initial report.

2. Engage in closed-loop communication with the paramedics. Listen to their report and then inquire about further details. Look at the run sheet while the paramedic is still in the room so you can ask clarifying questions.

3. Position the first response team welllisten, thank themand take the opportunity for a warm handoff from the paramedics. The initial trust and bond between the patient and first responder can transfer to the ED team.

Try This Challenge

Commit as a physician and nurse team to meeting each ambulance patient and doing team intake at the bedside. Think of one additional question to ask the first responders. Observe what the impact was for you, the patient, the nurse, and the paramedic team. 

Let us know in the comments how you interface with the first responders as patients come to your ED. We want to learn from you.

Interested in learning more about how our Emergency Medicine Patient Experience program can advance your organization’s engagement and patient experience goals? Take the first step with us by Getting Started.

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