Take a Seat 

Make a Connection To Raise HCAHPS

Bedside conversations with patients can improve both their experience and their outcomes.[1],[2],[3],[4]

Dr. Michael Kahn[5] describes etiquette-based medicine, a list of things doctors can do to show empathy: knocking on the door, introducing yourself, shaking your patient’s hand, explaining who you are, asking about their feelings, and sitting down to have a conversation.

These simple things come naturally in most polite social settings but are often ignored in hospitals. Research reports that providers don’t use etiquette at all with almost a third of patients, even when they have never met before.[5]

Etiquette is not just about scores. Sitting and talking with patients can help them stick to their treatment plan and strengthen the relationship between doctor and patient. Good relationships lead to fewer lawsuits,[6] shorter hospital stays, lower costs and improved health outcomes. Doctor-patient rapport even affects things like blood sugar and blood pressure.[7]

Sit Together To Make a Personal Connection

Overall etiquette leads to higher satisfaction, but when researchers looked at individual behaviors, the only thing that mattered was whether the doctor sat down in the patient’s room.[3] Patients want their providers to care about them, spend time with them[8],[2] and pay attention to their problems. Sitting to talk is a great way to accomplish that. In one study, when providers sat during the visit, patients felt like it lasted seven to nine minutes longer.[9]

Put Pen to Paper To Gain the Most Leverage From Seated Time

When providers sit and talk with patients, it is an excellent opportunity to teach. Helping patients understand their health conditions is critical. High-quality teaching improves outcomes,[10] but inadequate teaching has serious consequences.

Research in the Archives of Internal Medicine tracked mortality after hospital discharge. Five years later, 39.4% of patients with poor understanding of their health conditions had died, compared with only 18.9% of those with adequate knowledge.[11]

Up to half of patients report trouble remembering discharge instructions, but when they do remember, they credit providers sitting and explaining them with pen, paper, and printed materials.[15]

To help patients remember what you teach, use pen and paper. Draw diagrams, take notes, and provide materials to reference later. Being hospitalized can be a frightening experience. Facing uncertainty and a whirlwind of tests and treatments, it’s no wonder patients find it hard to remember everything.

Teach To Reduce Readmissions

Poor education before hospital discharge also leads to higher readmission rates, causing financial difficulty for hospitals.[12]

CMS reduces payment up to 3%[13] for hospitals with readmission rates over the national average. Many hospitals are currently operating in negative margins. With some of the best financial cases reporting a positive margin of only 1%, a 3% reduction from the main payor is catastrophic.[14]

Though readmissions are soaring, many are preventable. CMS reports 15% of all patients get readmitted within 30 days after discharge. Around 1 in 4 of those readmissions could be preventable.[15] Readmissions decrease when providers teach in ways that help patients retain information.[16],[17]

Conclusion

Talking with patients can improve HCAHPS scores and make a difference for your patients during a difficult time. For the best outcomes, put pen to paper and teach while you sit. Patients will remember what you said, and their experience and health will benefit.

References:

[1] Orloski CJ, Tabakin ER, Shofer FS, Myers JS, Mills AM. Grab a seat! Nudging providers to sit improves the patient experience in the emergency department. J Patient Exp. 2019;6(2):110-116. doi:10.1177/2374373518778862

[2] Strasser F, Palmer JL, Willey J, et al. Impact of physician sitting versus standing during inpatient oncology consultations: patients’ preference and perception of compassion and duration. A randomized controlled trial. J Pain Symptom Manage. 2005;29(5):489-497. doi:10.1016/j.jpainsymman.2004.08.011 

[3] Swayden KJ, Anderson KK, Connelly LM, Moran JS, McMahon JK, Arnold PM. Effect of sitting vs. standing on perception of provider time at bedside: a pilot study. Patient Educ Couns. 2012;86(2):166-171. doi:10.1016/j.pec.2011.05.024

[4] Golden BP, Tackett S, Kobayashi K, et al. Sitting at the bedside: Patient and internal medicine trainee perceptions. J Gen Intern Med. 2022;37(12):3038-3044. doi:10.1007/s11606-021-07231-4

[5] Tackett S, Tad-y D, Rios R, Kisuule F, Wright S. Appraising the practice of etiquette-based medicine in

the inpatient setting. J Gen Intern Med. 2013;28(7):908-913. doi:10.1007/s11606-012-2328-6 

[6] Moore PJ, Adler NE, Robertson PA. Medical malpractice: the effect of doctor-patient relations on medical patient perceptions and malpractice intentions. West J Med. 2000;173(4):244-250. doi:10.1136/ewjm.173.4.244

[7] Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ. 1995;152(9):1423-1433. https://pubmed.ncbi.nlm.nih.gov/7728691/

[8] Gross DA, Zyzanski SJ, Borawski EA, Cebul RD, Stange KC. Patient satisfaction with time spent with their physician. J Fam Pract. 1998;47(2):133-137. https://pubmed.ncbi.nlm.nih.gov/9722801/

[9] Johnson RL, Sadosty AT, Weaver AL, Goyal DG. To sit or not to sit? Ann Emerg Med. 2008;51(2):188-193, 193.e1-2. doi:10.1016/j.annemergmed.2007.04.024

[10] Auerbach AD, Kripalani S, Vasilevskis EE, et al. Preventability and causes of readmissions in a national cohort of general medicine patients. JAMA Intern Med. 2016;176(4):484. doi:10.1001/jamainternmed.2015.7863

[11] Baker DW. Health literacy and mortality among elderly persons. Arch Intern Med. 2007;167(14):1503. doi:10.1001/archinte.167.14.1503

[12] Bailey SC, Fang G, Annis IE, O’Conor R, Paasche-Orlow MK, Wolf MS. Health literacy and 30-day hospital readmission after acute myocardial infarction. BMJ Open. 2015;5(6):e006975. doi:10.1136/bmjopen-2014-006975

[13] McIlvennan CK, Eapen ZJ, Allen LA. Hospital readmissions reduction program. Circulation. 2015;131(20):1796-1803. doi:10.1161/circulationaha.114.010270

[14] Definitive Healthcare. A look at hospital operating margins in the United States. Definitive Healthcare. Accessed September 12, 2023. https://www.definitivehc.com/resources/healthcare-insights/hospital-operating-margins-united-states

[15] Auerbach AD, Kripalani S, Vasilevskis EE, et al. Preventability and causes of readmissions in a national cohort of general medicine patients. JAMA Intern Med. 2016;176(4):484. doi:10.1001/jamainternmed.2015.7863

[16] Townshend R, Grondin C, Gupta A, Al-Khafaji J. Assessment of patient retention of inpatient care information post-hospitalization. Jt Comm J Qual Patient Saf. 2023;49(2):70-78. doi:10.1016/j.jcjq.2022.11.002

[17] Becker C, Zumbrunn S, Beck K, et al. Interventions to improve communication at hospital discharge and rates of readmission: A systematic review and meta-analysis: A systematic review and meta-analysis. JAMA Netw Open. 2021;4(8):e2119346. doi:10.1001/jamanetworkopen.2021.19346