In the pre-pandemic era, relatives of patients would regularly visit hospital wards in the afternoon to see their loved ones and to get an update from the healthcare staff. Due to the Covid-19 restrictions, relatives are not routinely allowed to visit the hospital wards unless to spend time with patients who are deemed end of life.
This significant change in interaction of patients, families and healthcare professionals has created huge barriers of communication. We, as care of the elderly physicians, always stress that effective communication is the key for a better care and making right decisions. This equally applies to other specialities as well.
We tried to address this issue by formalising the communication with relatives. With the help of the ward manager, a ‘telephone call back service’ was initiated. The role of the ward clerkess has been instrumental to this as she would answer phone calls from relatives and triage to find out whether the doctor needs to make a return call.
A dedicated register was created to log the calls and she would tell the caller to expect the return call from the doctor on the same day till 16:30 hours. If no replies were received then to expect the return call on the next working day.
This was important as lots of relatives still manage with landlines (or may not carry mobile phone) and we did not want them to keep waiting at home for a phone call from the hospital. The call would be for ten minutes only and would involve a quick medical update including any medical concerns.
Once the doctors had called or tried to call they would document and sign the register with the date and time so we knew the return phone call back was done.
The ward clerk would place the register in the doctor’s office after 14:00 each day, but doctors were encouraged to pick it up earlier and fit in their schedule for the day.
In complicated and difficult cases where conversations would need more than ten minutes, the consultant called the relatives and discussed issues related to resuscitation, ceiling of care including ReSPECT (advance care planning) discussions, or explaining medical conditions.
We collected data between the 4th January 2022 and 1st Feb 2022. In this time we received 53 calls from relatives. Of this, 43 calls were returned on the same day. Unfortunately, two calls were not picked by the relatives. Ten calls could not be made on the same day.
Feedback was given from junior doctors to find out their perceptions of the service. A standard questionnaire was set up on the google drive, which were returned electronically. It was set up in a way that the answers were anonymous. There were questions with multiple choice questions and free text section for comments. Six out of eight doctors involved in this service rated it as effective service, one rated it as very effective and only one found it as not very effective.
The time spent over the phone was mostly between five to 15 minutes depending on the conversation they had. The limitations of the service as per the feedback included:
- Difficulty summarising a complicated patient with a big medical file of notes
- The relative not answering the call
- Different family members asking for updates
- Problems with finding time to call back as junior doctors were already overworked doing ward round jobs in the afternoon
- Some of the calls were mainly for discharge planning and not medical updates
- It was particularly challenging when there were a lot of staff sicknesses, which put a lot of strain on doctors already working hard.
Future suggestions would be to develop a more robust triage system because some of the relatives just wanted an update about physiotherapy, nursing issues or discharge planning rather than a medical update.
Also there should be a designated family member who could act as the spokesperson for the entire family. This would avoid miscommunication and ease the pressure on the overstretched junior doctors.
There should also be protected time for calling relatives as junior doctors felt it was very difficult to prioritise the time for this service. Although the service was set up for 10 minutes, it took at least another 10 minutes for preparation time and documentation. In essence one call would take any time from 10-25 minutes. If there were three calls to be made, one hour was easily used up.
Overall, the relative call back service was effective as it was well organised and structured. The main benefits were that the nursing staff or ward clerkess did not have to chase the doctor responsible for relative updates as it was part of the day duty.
Families, although not able to see their loved ones, felt they were still able to get the required updates. There was even some benefits for some of not travelling such as parking hassles or changing buses.
A couple of relatives did misunderstood the updates meaning the doctors had to read back to them summaries of the discussion. This was made more difficult by the fact the hospital does not a recording system as compared to general practice.
Overall, relatives felt less isolated and felt more in touch with the hospital if they got an update through a structured call back system that was functioning well.
Dr Abdullah Gujjar, SpR West Midlands Care of Older Adults Deanery, currently posted at University Hospitals of North Midlands.
Dr Lakshmi Shelly, SHO currently posted at Care of Older Adults Department at County Hospital, Stafford (UHNM).
Dr Anil Kumar, Consultant Physician & Geriatrician County Hospital, Stafford (UHNM) and also Clinical Tutor Keele Medical School.
Conflict of interest: none