The Intensive Care Bed #Hospital


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Here in the UK last night the BBC aired a programmed called “Hospital”. It was a very moving programme showing how stretched the NHS is. It certainly opened my eyes to the daily nightmares that consultants, managers and nursing staff find themselves in on a daily basis. The shortage of Intensive Care beds the result in operations having to be cancelled and patients being turned away for life saving operations. The look of frustration and helplessness etched on the faces of many.

How I felt for the patient that had his operation cancelled for the second time, being sent home after waiting in the ward anxiously waiting to hear that an Intensive Care bed was available – it didn’t happen the bed was needed for another patient.

It brought be back to when my mum was “that patient”. Extremely poorly with bowel cancel, awaiting a life saving operation. She was prepared for the op by having nil by mouth for 24 hours the day before the scheduled operation. By 4.00 that afternoon she was still waiting, we her family were waiting with her trying to keep her spirits up. Finally, I went along to the nurse’s station to find out what was happening to be told that her operation was cancelled due to there being no Intensive Care bed that she needed after her operation. Her operation was delayed to the following week.

The following week arrives, my mum another week on, getting weaker by the day but we were all optimistic she was having her op that day. It got to lunchtime and we got the dreaded news her operation was cancelled again for the 2nd time. The Intensive Care bed was needed for a man who was involved in a road traffic accident. I remember feeling anger at this person who I didn’t know – because of him my mum was not able to have her operation again – and then the instant guilt of feeling like that. This faceless unknown person fighting for their life as my mum was doing got the bed first – WHY!! I often wonder how their family felt – they probably just took it for granted that the Intensive Bed was there – as I thought before this nightmare began. Her operation was delayed for yet another week.

The 3rd week arrived – just a few days before Christmas. We were told previously that mum would be first on the operating list. I sat with her – her fight all gone. All 4 and half stone of my beautiful mum wasting away in the bed before my eyes. They came around to get her prepped for the operation. Excitement building like this was something that we didn’t believe was ever going to happen. Somthing that before this we had just taken from granted. Patients starting going down to the theatre – the consultant came up and asked if he could have a word with the family. His dreaded words “I’m sorry but we are going to have to cancel mum’s operation again” Our grief at that moment was unbearable. My heat was torn in two – how on earth could she survive another week. Amongst all of the shouting and swearing the panic and the disbelieve I still remember the look of despair on the consultants face. He just didn’t know what to say. He apologised and said that he would have felt exactly the same if it had been his family. It was the same story – they didn’t have an Intensive Care bed for mum after the operation.

I would never in my wildest thoughts that it would have been a bed that would have prevented my mum from having a life saving operation. It just didn’t make sense. I actually believed at this stage that this was just a lie – that they didn’t feel that mum at the age of 70 years was worthy of this operation. I felt they were just waiting on her dying.

The consultant went and spoke to mum. She had lost the will and just nodded – perhaps like me she thought that she was never going to have this op.

I remember mum saying she was hungry – I sent my Dad to get her a sandwich from the canteen. This has been her 3rd week of starving for 24 hours before being told she wasn’t having the op. She then asked the nurse for the commode. The nurse went off to get one. The nurse took longer than mum could wait and she attempted to get out of bed to get to the toilet – as ill as she was she still had her pride. As she stood upright the tumour burst – all over the floor. Within 10 minutes she was being rushed to the operating theatre where she had the operation.

She finally had the Intensive Care bed that she was promised 3 weeks ago, albeit only for 2 nights instead of the 5-7 she was told she would be in there for. She was  then transferred to the high dependency unit. I often wonder if someone had to be moved out of intensive Care to make way for mum, or if someone who was waiting for it had been cancelled like my mum had.

Watching the programme last night brought it all back. It made me see the nightmares that the staff have on a daily basis trying to access Intensive Care beds for patients. As the programme showed last night we in the UK have the most wonderful consultants with the most amazing powers to carry out life changing operations, the dedicated staff who work around the clock to look after the patients before and after their operations and the most marvellous well equipped hospitals that we should be so proud of. But how shocking it is to think that it sometimes comes down to the “luck of the draw” when it comes to needing that much-needed Intensive Care bed.

 

© 2011-2017 Reception Training all rights reserved
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Signposting – Have you got it right?


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I accompanied an elderly friend to the hospital yesterday. She had to go to see the neurologist.

I went with her as a friend but to also support her as she is in a lot of pain and finding walking difficult.

Parking as in most hospitals was pretty awful; we were lucky to find a space and then made our way into the hospital with plenty of time before her appointment was due. We entered the large outpatients department and found that they had completely reorganised the main area. There used to be an information desk, this now replaced by a super new coffee shop.

There was no sign to direct us to the neurology department so I stopped and asked two maintenance men who were deep in conversation propping up the door. One of them told us we had to follow the corridor to the end through the double doors and turn right, into the new part of the building. So off we went.

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We went through the double doors, and there were no signs of our destination. So I asked another member of staff, she sent us back the way we had come, and once again we ended up somewhere that certainly wasn’t neurology.

I then asked a 3rd person who actually told us truthfully that they had no idea where it was, by this point my friend was starting to struggle with her walking, I sat her down and asked a 4thperson. This member of staff asked me to follow her and she took me directly to the department which was situated right beside the two maintenance men who were still there chatting. I went back and collected my friend and we made our way back to check in.

We waited at the empty reception desk, still not confident that we were in the right department, and the time was fast coming up to her appointment,my friend started getting anxious as she does not like to be late.

The Receptionist finally arrived, apologised for keeping us waiting and asked her name. Thank goodness we were in fact in the right place – more by chance I might like to add.

I asked the Receptionist why there was a lack of signposting and she told me that there were several outpatients clinics held there on a daily/weekly basis and they would be unable to list them all, and often they change to other parts of the department.

So, Hospitals, large GP Surgeries and Health Clinics please ensure that your signposting is user-friendly and if for some reason if have not got a help desk, or you cannot put up the correct signs, please think of putting directions on the appointment letters, and perhaps appropriate training for staff in how to deal with patients/visitors when they are asking for directions. If staff are not fully confident that they know where the departments are, then tell the patient that, please don’t send them on a wild goose chase like we were yesterday.

Large buildings that have lack of signposting can often be confusing to the elderly and the disabled.

 

© 2011-2017 Reception Training all rights reserved

Eye Contact and a Smile


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A friend of mine had to go for an X-Ray yesterday at his local hospital. The hospital is in the process of going through some building work and many of the departments have been moved around – so finding the X-Ray department was somewhat of a challenge.

He followed the temporary signs to the X-Ray department and upon arrival asked the Receptionist if he was in the right place.

He was quite surprised by her attitude, he was made to feel as if he was a nuisance, and an inconvenience for being there. She replied quite abruptly that he was, took his referral letter and told him to take a seat.

At no time did the Receptionist give him eye contact, smile or show any signs of any customer care.

He sat and waited. There were another 4 people in the waiting room.

A nurse came out and called his name, the receptionist rudely snapped at the nurse and asked what she was doing and asked if she had taken from the bottom of the pile. My friend said that you could feel the nurse’s embarrassment at being spoken to in such a way, her red face for all to see.

The nurse explained to the Receptionist that the other people in the waiting room in fact were waiting to be accessed by her colleague before being seen.

My friend got up and followed the nurse, who was absolutely lovely. She welcomed him with a smile. She asked him how he was, and spoke about the weather and held a general conversation. He found her extremely friendly and this put him at ease.

I asked my friend how he felt about the two completely different approaches when be dealt with and he said that going into a Department people can be often worried and concerned as they could be going for tests that could have such a big impact of their life. Many people that are having tests at a hospital are feeling anxious and do not need to be met with rude staff.

He found the Receptionist unhelpful, uncaring and actually felt uneasy when being dealt with by her. He also found it embarrassing when she spoke in such an abrupt way to the Nurse, and he felt that she should not have done that.

As for the nurse, he found her lovely, helpful and put him at ease within the first couple of minutes. He felt able to ask questions about his test something he wouldn’t felt he was able to do with the Receptionists.

Staff have such a big impact on patients in the way that they deal with them, from the moment they walk into your organisation whether it be a hospital, or a Surgery every single member of your staff should treat every single patient with respect.

Eye contact and a smile speaks volumes.

3. DNA and the Patient’s Experience


I have had several people contacting me regarding my posts on DNA’s.

The first blog I did was the impact DNA appointments have on Hospitals and Surgeries.

The second blog was in response to a comment made by a Reception Team Leader and how her surgery is proactive in dealing with this problem, which I might add I think is a great system.

This the 3rd blog on DNA’s is from a patients point of view.

Someone contacted my regarding DNA’s and how this impacts on the health service resulting in people having longer waiting times for appointments.

This lady had a hospital appointment a couple of weeks ago, she realised the week before that due to unforeseen circumstances she was unable to keep the appointment the following Monday afternoon, and working in the healthcare sector knew how important it was to cancel the appointment and give someone else the chance of the appointment.

On the Wednesday the week before her appointment she tried to call the consultants secretary to cancel the appointment.

She was greeted with a recorded message saying that the secretary was on holiday and the secretary actually said in the recorded message there was no facility to leave a message. She asked that people call back on her return in 10 days time.

Obviously this would be too late to cancel the appointment. So this lady phoned the hospital and asked for outpatients department, the switchboard put her through and it rang and rang and no one answered. So she had to phone the main switchboard back again. She explained that no one was answering in outpatients, but she was put through again anyway – and again no one answered. So, she had to phone back yet again, she explained about wanting to cancel her appointment, before she could say much more she found she was put through to the “secretary” again, and heard the message she originally heard – and the fact she couldn’t leave a message!

She gave up at this point and left it until the next day when she tried again. She said that she was put through to several different departments, no one wanting to take responsibility for the call she was even told to phone the secretary on her return in 10 days time. She explained that the appointment was in fact in 4 days time and wanted to cancel it and not have a DNA against her name.

She got nowhere – so tried again on the Friday – the same run around.

Monday morning the day of the appointment she phoned the hospital and finally got put through to someone – she explained that she was unable to attend her appointment that afternoon and could they cancel it and ask the secretary to send her out a new appointment.  After taking the woman’s name said she would.

Two weeks went by and this lady had heard nothing so she telephoned the consultants secretary who was not back from her holidays – and to no surprise she found that they appointment had NOT been cancelled, she in fact had a DNA against her name, and the secretary did not get the message about her wanting another appointment made.

To say she was fuming was an understatement.

So, in order to get the DNA rates reduced it takes time and effort from all involved.

Patients have to be more responsible for cancelling appointments and this needs to be dealt with in a delicate manner.

Surgeries and Hospitals need to ensure that if a patient does cancel their appointment that it is recorded and cancelled and the patients does not received a DNA against their name.

Hospitals and Surgeries cannot moan about the amount of DNA’s they have unless they have a policy in order that will actually deal with this when the patients requests to.

And systems have to be in place that these messages are getting through to the right people.

The lady involved felt that no one wanted to listen to her – the operator just didn’t listen to what she was saying which resulted in her being put through to departments that if she had been listened to could have been avoided.

I would suspect that most patients after the first 2 or 3 phone calls would have simply given up trying to cancel the appointment.

The Importance of Giving Your Change of Address


I have written about policies and procedures and the importance of them – let me share an experience I had while working as a Manager – and the importance of ensuring that every job is carried out no matter how each and every one of them carried out responsible jobs, dealt with difficult people at times as well as at times grumpy doctors.

Some people see a Doctors Receptionist role as a “cushy little number” after all they just sit behind the desk booking people in and making appointments. If only!!!

Each and every Receptionist is constantly running around like headless chickens. Often not stopping for a cuppa and working through lunch breaks to get their jobs done. On top of being at the Reception Desk booking patients in and answering the telephone they also have individual tasks to deal with. Prescriptions to be sorted and printed ready for the Doctors to sign.  Preparing Medical Reports for the Doctors to sign, ensuring that all relevant claims forms are sent into the local Health Authority, ensuring that all clinics are set up correcting onto the computer system (and usually when they have done this a Doctor or Nurse will decided that they want holidays and it all has to be changed again) Inputting data to ensure that patients are monitored and recalled to the Surgery for checks such as Blood Pressure, Diabetics, Heart, and many more clinics – scanning and the never ending job of filing – the jobs are just endless.

One of the jobs that are allocated to a Receptionist is “change of address”. This is when a patient moves house. They will come in and advise us that they have moved. They will be asked to complete a form and this would then be given to the appropriate Receptionist to change on the computer and the patients notes.

This was seen as one of the less important jobs – and the Receptionist doing this job worked 3 days a week – so often a change of address could often be in her tray for a few days – and longer if she was on holiday.

That was until…………………………..

A patient came into the surgery to see the Doctor – she was 35 years of age a wife and mother of 2 children. She was complaining of stomach pains. The doctor examined her and felt it would be best to refer her to the local hospital for more tests.

The doctor dictated the letter while the patient was sitting in front of her.

The patient came out of the surgery and went to the front desk to book another appointment and then informed the Receptionist that she had in fact moved – the Receptionist asked her to complete the appropriate form and put the form into the Receptionists tray that dealt with the changes of addresses.

Later on that afternoon the secretary typed out the letter to the hospital that the Doctor had dictated. Can you see what happened next?????

The letter went to the hospital with the patients old address on as it had not been changed on the computer or the patients notes.

The patient came back to the Doctor about 6 weeks later saying that she was feeling worse and still had not heard from the Hospital.

The Doctor telephoned the hospital and after a while it was discovered that the hospital had written to her old address with an appointment and she failed to attend they never follow-up on failed appointments.

The doctor at this point was extremely worried and asked for the patient to been seen asap. She was and it was discovered that she had stomach cancer.

The paitent underwent surgery and treatment but sadly died some months later.

Her husband came in to see me some weeks after her death to ask what had happened and why they letter had gone to their old address.

I was mortified – I just felt so awful for this poor man – left without his wife and now had two children to care for that had lost their mum.

He said that he was not there to put blame on anyone – he just wanted to make sure that it didn’t happen to another family – he said that the hospital had indicated that she had the cancer for some time – but as he said – what might have been if she had been seen earlier. And I must admit I could fully understand what he was saying.

I assured him that I would look into our procedures and I promised him that nothing like this would ever happen again. He  left the surgery a devastated man – I went up to my office and cried – it was just awful.

So, from that day on our policy on “Change of Address” changed. Every single Receptionist as soon as she was given a change of address it was to be entered onto the computer system and the patients notes immediately.

It goes to show that this “little” job was so so important and could not be left a moment longer than necessary no matter how small you might think it is at the time.

The Receptionists at the Surgery always worked extremely hard – long hours and for nothing more than just above the minimum wage – I always said that these girls were worth their weight in gold – more than a Receptionist and should have been recognised for this.

So for any Doctors Receptionist/Manger reading this please adopt this policy and ensure that whenever you have a patient change of address its done immediate.

And

If you are a patient reading this and you move house PLEASE inform your Doctors Surgery immediately.

I also discovered over the years that many patients moved house and never ever let their surgery know – patients either forget or don’t think its important. So regular notices in your Surgery to remind patients to let you know if they change address or telephone numbers is also a good start to ensuring that you have their up to date information.

A Tragic Tail


 

I spoke to my daughter this morning and she was pretty upset. She had heard some very sad news about a friend – let me explain what happened

My daughter walks her dog at a regular time each morning and has formed friendship with other people who walk their dogs at the same time.

One particular girl she has got to know quite well over the past year was due her baby last Monday – she was having a girl and they had even named her. My daughter looked forward to the daily meetings and the updates on her pregnancy.

Last Sunday her friend was not at the park – my daughter wondered if she perhaps had the baby. How exciting if she had she thought.

Then on Tuesday my daughter met up with another regular on the park walk. The woman asked my daughter if she had heard the news – my daughter expecting her to say that her friend had in fact had the baby.

She had, but what she heard next just was the most awful news.

Apparently the girl was walking her dog on the Sunday (the day before the baby was due) and she met up with another “doggy” friend who had not been in the park for some time – this woman’s dog is a large bred and his owner had suffered with a bad back and was unable to take him to the park. The stood chatting and the big dog suddenly ran past them both and knocked the pregnant girl right off her feet – it was a pretty nasty fall and they had to call an ambulance.

She arrived at the hospital and they discovered that in fact the placenta had actually come away – resulting in the hospital having to give her an emergency caesarean. Her baby girl sadly dies 6 hours later. How awful. Such a freak accident and such a terrible tragedy.

We discussed how awful it must be for everyone – including thewoman’s whose dog it was. My daughter said that she was  due home a couple of days after the birth – and that apparently her mum had gone in and taken all the baby items away –  because she probably
would not want to face it when she came home. This took me back to a mum that was a patient at the surgery……………………..

When I worked as a receptionist one of my duties was to “manage”
the anti natal clinic one a week. I was responsible for helping the midwife
during her clinic – I would help book mums in, get their records ready and
weigh them before they went in to see the midwife. I loved this as I got to
know the mums all the way through their pregnancy and they would always bring
their babies in to see me when they were born. I always had a special bond with
these mums and their babies too.

But, there were the odd one or two that didn’t get to show their babies off – it might have been due to a miscarriage or a stillbirth – every one of them so very sad.

One particular mum had a baby that had died a few hours after giving birth. We were always notified from the hospital when such a thing happened. Every effort would be made to ensure that the patient would have easy access to the Doctor, Nurse or Health visitor if they needed. (I did in fact set up a procedure to ensure that people who were terminally ill or recently bereaved had easy access and I will tell you more in a future blog).

She came into the surgery about 2 weeks after she lost her baby. She came to the desk – I told her how sorry I was and asked if she was ok. She started crying – I took her into a private room – she went through the events of losing the baby – I felt she needed to talk about it I sat and listened. But what she did say and has stayed with me all these years – and make me think of it again this morning.

When she came back from the hospital after losing her baby she found that everything had been taking out of the house that was there for the baby.

Everything had gone the pram the cot, the mobiles, the furniture everything that they had bought together with all the clothes and baby toys. Someone had thought it would be the best thing to do.

But she said that walking into the house and everything gone was like the baby was never real. It was like stepping back 9 months – she felt that everyone had just wanted to get rid of the memory of being pregnant or even the baby. She knew that this wasn’t true but that is how it felt at the time.

She said that what she had wanted to do was go home and grieve – she couldn’t do that in the hospital. She wanted to go home and go into the baby’s room and say goodbye there – surrounded in the love that had been put into everything in the room – it was the one last time she felt she could be close to the baby and that was taken away from her.

She explained that she hadn’t told anyone how she felt as she didn’t want to put guilt on anyone’s shoulders. After all her husband and family has been though a lot too. She realised that they were trying to spare her any more hurt and pain.

So although we think we might be doing the right thing at the time – are we? I hope this never happens to anyone close to me – but if it did – I think I would ask the mum what she wanted to do.

Sarah – My First Experience of Death


Having never worked within the healthcare sector before certainly was an eye opener, the pace that everyone worked at, the different services that the Surgery offered and the sheer volume of people through the doors and the phones that never stopped ringing.

But I love it. Every day brought something new – I was constantly learning new skills together with getting to know the staff and the patients. For once I enjoyed going into work every day.

Don’t get me wrong there were ups and downs – Doctors getting grumpy with the Receptionists because they put extra’s into their clinics, Patients getting grumpy because they couldn’t get their way – and other receptionists getting grumpy because everyone else was grumpy with them.  But you got through those days and came out of them to face a similar one the next day.

One of my very first patient memory was a mum called Sarah. I had spoken to her several times on the phone and she always seemed to be very anxious. She always asked for an appointment. On speaking to other receptionists it soon became clear that she was a “regular” to the surgery.

Over the years working in Reception I got to know our “regulars” very well. Now regulars can again come in all shapes and sizes. We have the regulars that need to be seen by the doctors for one reason or another, and are pretty poorly and we have the regulars that perhaps don’t need to be seen quite so often. These patients do take up a lot of time and money from the NHS. They take up Doctors appointments; they request tests that require nurses, or hospital appointments. More often than not their tests all come back clear. But as a Receptionist it was not my place to judge – if a patient asked for an appointment they would get one. But you can’t help getting a bit frustrated by a patient demanding to see a Doctor in an emergency slot for a runny nose that they have just developed that day – and usually the regulars know the system and know that if they insist on being seen that day they we have to offer an appointment.

We used to get a lot of anxious mums – again we would never refuse for a baby or child to be seen. But a lot of times the child might just have a cold or teething. It did occur to me that a lot of these young mums did not have the support from older experienced family members – they were often single mums or a first time mum with no guidance from a mum or gran. Sad really as all they needed was reassurance from someone – so often they had no one else to turn to other than their Doctor.

I remember one of the Doctors saying once that he felt more like a social worker than a Doctor.

So, back to Sarah – she would phone on a regular basis – and it was always for the same thing – her back. She would come into see the doctors – they ordered tests on her back and blood tests and all came back clear. After a while the doctors and the reception staff began to wonder if there was actually anything wrong with her at all. But she insisted that her back was bad.

I liked Sarah – she wasn’t like one of the “regulars” that didn’t have anything wrong. She never caused a fuss she just wanted an appointment.

She also had 3 beautiful daughters – age 8, 5 and 3. They were always dressed beautifully and always very well-behaved when they came into the surgery. We rarely seen her husband but all in all a lovely family unit.

Then Sarah became ill. She was admitted into hospital. She had cancer in her back. The surgery was in shock – and more so the doctors as nothing had shown up in any tests.

Sarah sadly died some weeks later. I was completely devastated by this – it was the first patient that I had known died at the surgery. All I could think about was she was right – she knew that there was something wrong.

I couldn’t sleep at night for thinking about those 3 little girls – their mummy now gone.

But if I wanted to carry on working in the Surgery I knew that we would lose patients again and again. But what I never have ever forgotten from that day to this is NEVER judge and think someone is “putting on an act” I have no right to judge – and from that day to this if someone requested appointments time and time again they were treated with respect and given the appointment.

Sarah’s husband gave up work to look after the girls – he would come in from time to time with one of the girls. He seemed to be doing a great job of looking after them – he still kept them immaculate – they were a credit to him. Sarah would have been so proud of them all.

I used to chat to him when he came in – I asked how the girls were coping and how he was coping. He always seemed to enjoy our chats. He told me that he was getting on very well – he still missed Sarah but the girls were keeping him going, but one thing he did have problems with was their hair – every one of them had the most beautiful long hair – but he just couldn’t “do” long hair. The girls had to wear their hair back or up for school. Often, They often wanted it platted or put into pigtails – he tried and tried but just couldn’t do it. He said there had been more tears over hair in the house than anything else.

He said that it would be so much easier if they all had short hair –  but their long hair had always been Sarah’s pride and joy and for that reason he would battle on and try his very best to do that pigtails.

I cried that afternoon when I thought of that poor man – coping with the loss of his wife, being a dad and a mum to the girls and trying very hard to create that perfect hair style.

© 2011-2017 Reception Training all rights reserved