Ten years after Denver General changed it’s name to Denver Health Medical Center, Dr. Pons was still referring to the institution as D.G. and still answering the bio-phone with his same, hallmark gruffness. Any medic who worked in the Denver metro area from the mid 1970s till very recently was accustomed to the short, intolerant voice of Dr. Pons on the bio-phone and the feeling his presence often induced.
There was a lot to like about Dr. Pons. As a physician, he was as good as they come. And he didn’t tolerate bad medicine or poor performance from anyone. If you fumbled through your bio-phone report or didn’t know what you were calling for, Dr. Pons would make you hang up, think about what you wanted to say, and call back. No kidding. He also helped to write one of the best EMT textbooks on the market.
I wish we had more docs like Dr. Pons. We’d all perform better medicine and we’d also probably be a lot smoother on the bio-phone. Here are a few tips to help you stay relaxed on the bio-phone so your next report can be a well-organized exercise in smoothness, instead of a fear inducing drama. With any luck, you’ll never get the hang up treatment, even from the gruffest of E.R. docs.
1) Think about what you’re going to say before you call.
Domenic, a paramedic friend of mine, had a great story about Dr. Pons giving him the callback treatment. Dominic got off balance during a call-in report and stumbled over his words. He got nervous and disorganized and, before he knew it, the whole report feel apart. Dr. Pons interrupted. “Look, this is what you’re going to do. Hang up the phone. Think about what you want to say to me. When you know what you want to say, call back.” Click…the line went dead.
And so he did.
Domenic’s next call was much smoother and he eventually got the medication order that had prompted his call. We could all take Dr. Pons advice on this one. Before you make the call to the hospital, think about what you want to say. You don’t need to rehearse it. It isn’t a Broadway play or anything like that. Just consider why you’re calling and what you want to tell the doctor or nurse on the other end of the bio-phone. How are you going to describe the patient? What re the key elements you need to include?
2) Know why you’re calling. (And ask for what you want.)
In most EMS systems, the vast majority of call in reports are to let the hospital know you’re coming. These reports are typically simple and strait-forward. They’re also a great opportunity to practice for the more stressful reports like medication orders or medical refusals.
If you’re calling to notify the hospital that you’ll be arriving soon with a patient, they want to know when you’ll be there, what bed they need to get ready and if they need any additional resources standing-by when you get there. These calls are a great opportunity to practice painting clear, concise pictures of the patient in front of you in a low stress situation.
When the patient is an against-medical-advice refusal (A.M.A.) let the doctor know why you’re calling and tell him your impression of the patient’s right to refuse before you launch into your story. Don’t make the doctor guess at what you’re thinking. They’ll tell you if they agree or not.
If the call is for a medication order. Tell the doctor what medication you’re calling to request before you start your report. Let them hear the report in the context of the medication order being requested. Often, our failure to get the drug order filled is a simple matter of not giving the doctor enough insight into what we wanted in the first place. Even worse, sometimes we never get into the habit of asking at all.
I listen to medics get upset at the darn doctor who wouldn’t give them their medication order, “I can’t believe Dr. MacGregor didn’t give me a Morphine order on my chest pain patient!” The truth of the matter is, they never asked. They gave the report, they sounded uncertain about what to do next and they left an awkward pause at the end of the report. If you give that sort of report, don’t be surprised if you hear a polite voice on the other end of the radio say something like, “Thank you and continue transport. We’ll see you when you get here.”
I know, it can be intimidating to put yourself out there in front of our medical control and say, “This is what I want to do.”, but it’s important. If there is any single defining factor that differentiates the EMTs and medics who get their medication orders filled regularly from those who don’t, it is this; medics who ask for their orders, get their orders. “Dr. Bergner, this is EMT Hansen, I have a 68 year old male with chest pain and I’m calling for an order to administer nitro. This patient is currently…” or, “Hi Dr Kanowitz, this is Steve, the paramedic on medic 42 this evening. I’m calling for an order for Amiodarone and possibly a cardioversion on an adult male in v-tach. This is what I have…”
3) Ask if they can hear you.
Now that most facility communications have moved to cell phones, many providers have dispensed with this courtesy, but I still find it a useful way to start a report. “Good evening Memorial, this is Steve on medic 42, do you hear me alright?” A communications check will give the doctor or nurse a moment to grab a pen and compose themselves.
Just because they answered the phone doesn’t mean they’re ready to record your report. Ask if they can hear you, then give your report. You’ll find that you’re asked to repeat yourself a lot less often and the call-in will progress smoother if you use this common greeting.
4) Use the same format every time.
I use the same format in every report I give. It doesn’t matter if I’m writing a patient care report or talking to a doctor on a bio-phone or delivering a verbal report to a crowded room in the middle of a trauma activation. I start with the patient age and a brief summary of what happened. Then I tell a detailed story followed by a description of my assessment findings and then my treatments so far.
The content and details for each report may differ drastically depending on the type of report and patient condition. A bio-phone report won’t contain nearly as much detail as a hand-off report in the patient’s room and that report won’t contain all the details of my patient care report, but the format never changes. If I get off my format, I forget stuff, and things go badly. Find a format that works for you and stick to it.
If you’re thinking that my format sounds a lot like the S.O.A.P. format, you’re right. Your own style will dictate the format that works best for you. So will your system. When I worked out in the California desert, the hospitals in Lancaster were crazy about the Glasgow Coma Score. They had to have it, and if you didn’t say it, they were sure to ask for it. I prefer to give a more detailed description of the patients level of consciousness, so I rarely reference the Glasgow and nobody seems to care. Out in sunny California, it was an essential component of every report.
5) Keep it conversational.
A little informality can do wonders for your report. This is like the old advice about talking to one audience member at a time when giving a speech or pretending an interview panel is wearing their underwear. If you can keep things informal, you’ll be less nervous and you’ll perform better.
Whether you’re on a radio or speaking on a cell phone, when the hospital answers, just talk to them. Just speak like the two of you are talking about a patient you had last week. Learn your format and know what you want to say, but before you launch into a Gettysburg address type formal dissertation, relax and just talk. The hospital will be more apt to ask questions and even cut you a little slack if you forget a detail or two.
6) Know how to ask for a mulligan.
Sometimes, reports just go badly. Unfortunately, it tends to be at the worst possible times. The more people listening and the more critical the patient, the more nervous you get and the more likely that the report will start weak and devolve into a jumbled mess of information. It’s OK. It happens to everyone. When things go down bad, don’t stand there and pretend you were spot-on. Everyone knows that you weren’t.
Ask for a mulligan. You know what a mulligan is right? In golf, a mulligan is the ability to retry your first tee shot if the first one goes poorly. A mulligan is a do-over. You can ask for a do-over. Nobody’s going to take away your birthday. When the report goes wrong, fill in the details as best as you can and then say something like, “Wow, that was kind of a jumbled mess. What did I miss?” Smile. Laugh at yourself. Start again if you need to.
Once you’ve asked for a mulligan and found that most nurses are more than happy to help you piece back together the missing elements of a bad report, you’ll be more relaxed for the next time. When you’re more relaxed, your reports will get better. As your reports get better, you’ll find that you need to ask for mulligans a lot less often. I’ll see you on the tee box.
Now it’s your turn: What are your tips for a flawless hospital report?