Managing Expectations Watch

Renal
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#1
Report Thread starter 7 years ago
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How do you do it?

I almost always got stick after patients had waited for investigation results before being discharged from A&E.

I almost always get; "You've made us wait and now you're telling us to go away."
I would always respond along the lines of; "I've made you wait whilst I've checked that you are well enough to go home, since you are, you can now go."

I will admit that I didn't always commit to a "If this is negative you go home" position early on but I always explained what I was doing a blood test for "To see whether there are any signs of infection" / "To see how dehydrated you are" / etc. And always explained the results and the implications.

Fundamentally all very unsatisfying. Any tips?
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Fission_Mailed
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A crazy, far away look in your eyes and a slight twitch?
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Ataloss
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#3
Report 7 years ago
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(Original post by Renal)
How do you do it?

I almost always got stick after patients had waited for investigation results before being discharged from A&E.

I almost always get; "You've made us wait and now you're telling us to go away."
I would always respond along the lines of; "I've made you wait whilst I've checked that you are well enough to go home, since you are, you can now go."

I will admit that I didn't always commit to a "If this is negative you go home" position early on but I always explained what I was doing a blood test for "To see whether there are any signs of infection" / "To see how dehydrated you are" / etc. And always explained the results and the implications.

Fundamentally all very unsatisfying. Any tips?
I always give an initial management plan to patients when I see them in ED and if I am expecting to send them home dependent on tests I tell them and the treatment I would plan to discharge them with.

Doing this at this stage also gives you a warning shot that if the patient is expecting/wanting to be admitted you may need to spend longer explaining why they are safe/appropriate to be discharged when you come to do this.
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j00ni
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Report 7 years ago
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As with ataloss, explain clearly what the plan is any why you're doing the tests. I find it helpful to give an estimate (overestimate) of how long it will take, which coincidentally is often their breach time, and then add "but I will ring the lab/x-ray/etc and see if they can hurry things along for you. That way when the tests are all back in less time you can take credit and they end up thanking you.

edit: once in a while you may want to consider actually ringing the lab as promised to silence that pesky conscience we all get lumbered with
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Jamie
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#5
Report 7 years ago
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(Original post by Renal)
How do you do it?

I almost always got stick after patients had waited for investigation results before being discharged from A&E.

I almost always get; "You've made us wait and now you're telling us to go away."
I would always respond along the lines of; "I've made you wait whilst I've checked that you are well enough to go home, since you are, you can now go."

I will admit that I didn't always commit to a "If this is negative you go home" position early on but I always explained what I was doing a blood test for "To see whether there are any signs of infection" / "To see how dehydrated you are" / etc. And always explained the results and the implications.

Fundamentally all very unsatisfying. Any tips?
Mostly do what you are doing - explain why you are doing the test early on.
I do tell them my initial thoughts early on and my plan. If test negative home. If positive I'll discuss with the specialists to see if they want you to come in (that way you don't appear to be promising them they'll come in).
Give them a rough ETA (+30mins) telling them one of tests you ordered takes a while to process on the specialist machine.

Everytime I wander past the cubicle I tell them 'results not back yet, everything ok?'. Lets them know they arent forgotten.

Thats about it really. People really seem to respond well to the action plan. Makes them feel empowered/involved, especially when they phone their relis to tell them whats going on.
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