Epidemiology

1. 1-3:1000
2. Higher in females, educated, wealthy, young, parents, urban
3. Approx 1/3 related to staff that do not work in the ED
4. Majority of dissatisfied patients do not complain
5. ~50% substantiated

Classification of complaints

1. Medical – real or perceived (~50:50)
   1. Triage – esp parental overestimation of child’s illness
   2. Diagnosis – missed fractures, worse if GP was correct and ED was incorrect
   3. Treatment – inadequate analgesia, need for Xray, antibiotics
2. Interpersonal skills 32%
   1. Identification – failure of doctors
   2. Explanation of test, procedure, process
   3. Insensitivity or roughness – real or perceived
   4. Poor communication – language, use of jargon
   5. Failure to explain triage system or reasons for waiting times (thank you for waiting)
3. Delays – perceived more important than actual
4. Environmental issues – comfortable WR, clean, private and temperature controlled, staff eating not seen by those waiting, meals for patients
5. Administrative – incorrect documentation, lost records, lack of confidentiality
6. Financial issues – esp private hospitals, incomplete or misleading medical certificates

Management of complaints

1. Rectify source of complaint if possible, incl treat any outstanding/urgent medical issue
2. Personnel – one senior person
3. Acknowledgement – 24 hours for written complaint
4. Investigation – staff and records
5. Response – 3 days for written complaint, apologise for patient distress and dissatisfaction, without admitting liability
6. Documentation and appropriate involvement of hospital admin, MDU
7. Feedback to staff, QA, prevention

Prevention of complaints

1. Supervise junior staff
2. Review pathology and radiology
3. Good communication – explanation of triage, management, follow up and supervision
4. Provide clean environment and separate place for staff to relax / eat

Increased patient satisfaction

1. Perception of staff care
2. Perception of organization of the service
3. Perception of the amount of info provided
4. Provision of written follow up letter
5. Improved patient compliance

Exam Complaint Questions

1. In any complaint question there are likely to be at least two parts to the question –
   1. Manage the critical incident that the complaint cites
   2. Manage the complaint

Motherhood statement/issues:

1. Complaint
2. Critical incident/Adverse outcome

Complaint:

1. Immediate:
   1. Apologise for patient dissatisfaction
   2. Try to immediately address/rectify problem as appropriate
   3. If unable, inform pt of hospital complaints process
   4. Thank them for complaint as way to fix system problems
2. Manager:
   1. Identify best person to handle complaint process
   2. Identify best forum for handling complaint
   3. Private, quiet, unhurried
3. Acknowledgement
   1. Within 24 hrs
   2. Phone / writing / face to face
   3. Apologise for their dissatisfaction
   4. Recognise seriousness of issue
   5. Issue is being investigated
   6. Will keep you informed of outcome of investigation
   7. Who and how to contact re further info
4. Investigate
   1. Interview complainant
   2. Involved Staff
   3. Medical records
   4. R/V pt journey
5. Response / resolution
   1. Try to answer within 72 hrs
   2. Answer w/o judgement/emotion
   3. Apologies:
      1. Honest and sincere
      2. Acceptable resolution in 25%
      3. May include apology for
         1. Communication / Misunderstanding
         2. Pt/Family distress / dissatisfaction
      4. Not formal admission of guilt/liability
      5. Not acknowledgement of incompetence/negligence
   4. Respond to specific critical incident/adverse outcome as below
6. Consultoid: BΨSLEDP

Critical Incident/Adverse Outcome:

1. Immediate
   1. Manage pt/problem
2. Manager
   1. Identify best person/forum for resolution of incident
3. Acknowledge
   1. Feed into systems for handling incident
      1. IIMS
      2. RCA
   2. Inform stakeholders
      1. Department heads
      2. Hospital admin / legal dept
      3. Staff involved
      4. Medical defence
4. Investigate
   1. Involved staff
   2. Medical records
   3. Review patient journey
      1. Identify where it deviated from ideal
      2. Pre hospital
      3. Triage
      4. Wait
      5. Medical and nursing review
      6. Communication
      7. Investigation
      8. Synthesis of info
      9. Systems / Protocols
      10. Disposition
   4. System may fail on multiple levels
   5. Communication issues often predominate
5. Response
   1. Medicine
   2. Equipment
   3. Policy/protocols, Systems change
   4. Education
   5. Staff
6. Consultoid: BΨSLEDP