The Killers in Our Midst: Are Patient Progression Delays Killing Your Patient Satisfaction?

By Erin LaBarge

I'm trying to stop killers. 

The "killers" I'm talking about are found in every hospital across the nation.  They threaten your patients every day.  I'm talking about delays to patient progression.  Delays can weaken and even kill patient experience and satisfaction, and impact quality outcomes.

The good news is that many delays are avoidable.  These patient satisfaction killers can often be identified early and addressed proactively by the care team.  Here are some of the top delays to look out for:

Communication

Communication delays or miscommunication is the first patient satisfaction killer.  In the chaos of the day, communication from clinical staff to patients and their families is often incomplete, rushed, or delayed.  This leaves patients and their families confused and anxious and can erode their confidence in their care team.  

HCAHP’s patient experience-focused survey questions specifically focus on the quality and consistency of communication from nurses and physicians.  How do you think the patient will answer those questions about whether the nurses and doctors communicated well when his experience includes a "surprise echocardiogram"? How will another patient respond when she was never updated by the clinical team that her discharge can no longer happen today, and what about her friend who took off the day to get her home?  How does the family member feel when they ask the nurse for an update on their loved one’s care only to hear the nurse never heard this part of the plan from the physician but will get back to them? 

Patients and families need early, regular, and aligned communication from the care team.  This should be part of your daily process and every patient's care plan.

Consults

Delayed consults can wreak havoc on patient flow and progression.  The recommendations of the consultant (e.g. physician, therapist, etc.) are often needed to determine the next step in the patient's plan. Discharge orders are even written with contingencies such as "Patient OK for discharge with sign-off from Cardiology."  This type of delay impacts both your patients and the care team members who are taken away from the patient's bedside to chase down the consultant for answers.

Sound familiar?  What happens when the consult order is written after Cardiology has already rounded and has gone to their clinic?  You guessed it. The patient is going to be waiting again and the care team can’t begin the next step in progression. The Cardiology team is also frustrated. They would have seen the patient that morning had the consult been ordered. This further strains the relationships between care team members.

Testing and Diagnostics

Delayed testing is another top offender impacting a patient's progression toward their care goals.  Lags in the scheduling and resulting of tests cause delayed diagnosis.  When diagnosis is delayed, so is the physician's decision on the next step in the patient's care.

In a recent study of patient progression barriers, my colleagues found that a diagnostic delay can take an average of 1.8 days to resolve.  It is incredibly important that the barrier be identified and resolved as early as possible by care team members.  If my patient has a target LOS of 4 days, and I don’t identify the discharge barrier until day 3 (or even late on day 2), I’ve already lost time when it comes to meeting the target LOS goal.  That means the patient will also fall behind in advancing toward his or her care goals.

We all know the longer the patient is in the hospital, the more likely they are to develop complications.  The more the patient waits unnecessarily, the worse they view their overall experience.

Discharge Planning

What happens when discharge planning is not timely?  Imagine your patient requires placement to a facility. Last-minute discharge planning will delay and disrupt patient flow and on-time discharge. The patient's family often wants to research choices for placement and facilities have to give a bed offer. If this isn’t started early in the stay, the patient may be medically ready to go and have no destination lined up for them to be discharged.

Early identification and engagement by care team members to evaluate the patients needs can proactively address the patients post-acute level of care requirements and align care team members on the discharge planning goals. Instead, the patient and family are frustrated, the care team is monitoring the patient to prevent further decline, and the discharge plan changes as a result of the changes in the patient’s condition during the wait. This patient is also taking up the bed that a patient in the ED may require. This delay has negatively impacted your patient in the bed as well as those who are waiting for their care to begin.

Prior Authorization

Finally, prior authorization delays can postpone the start or continuation of necessary treatment.  This can result in a negative patient outcome which may include pain or complications that could have been prevented with earlier treatment.  This could be as simple as early identification of medications that will require prior authorization.  This process has to start well before a patient's expected discharge, or the patient may not have a safe discharge plan. A prior authorization delay could result in a large bill for the patient or readmission when the patient is unable to follow the treatment plan.

Delays are a major contributor to negative patient experiences and quality outcomes, but they can be avoided.  With a little vigilance and knowing what to look for, we can identify and resolve delays proactively before they kill our patients' experience and ability to progress.