Mater Hospital

8 Summary and conclusions

Communication and information in A&E

The casualty staff had clearly listened to the patients when they explained about their health problems. In addition, the staff frequently explained about the tests and procedures that were carried out and the treatment that was provided. However, in some cases, the staff did not explain, or did not adequately explain, about the tests, procedures and treatment. Indeed, a casualty doctor was perceived to be insensitive in commencing a procedure before explaining to the patient the pain that this would incur.

As regards preferences for treatment, in a few cases, the staff had not asked the patients about their preferences. Whilst the patients themselves did not necessarily see this issue as important because they were admitted for emergency treatment, nevertheless, perhaps they were accustomed to being passive recipients because they have not previously been given the opportunity to express their views.

In general, the staff had provided adequate explanations of why the patients needed to be admitted. However, in one case, the staff explained this to the patient's daughter, rather than to the patient herself. Whenever the patients had to wait in A&E for hospital beds, the staff always explained the reasons for the delays and kept the patients' relatives informed of what was happening to them.

The patients were generally satisfied with the information which they had been given in A&E. However, some patients lacked the confidence to ask medical staff for information, because they felt that they would be unable to understand the information provided. Indeed, one patient was confused by the information which he had been given by different doctors.

Communication and information in admissions ward

Most of the patients knew what to expect from their stay in the admissions ward because they had previously been admitted to the hospital.

The doctor-patient communication had been satisfactory in most cases, such that the doctors had listened to the patients; provided them with sufficient information; spoke directly to them and ensured that they understood the information they were given. In addition, these patients were given the opportunity to ask any questions. However, in a minority of cases, the doctor-patient communication was less than adequate. In communicating with two medical patients and one surgical patient, the doctors did not translate their medical terminology into language which the patients could understand. Consequently, the surgical patient did not understand what her planned operation actually involved (although when she was subsequently transferred to a surgical ward a consultant explained the operation to her in terms that she could understand). In addition, part of the communication breakdown in one case also arose because the doctor did not speak directly to the patient herself, but instead spoke to the other doctors present. In addition, the medical staff did not ensure that a hearing impaired patient could actually hear the decision that had been made regarding her discharge.

Communication and information in medical and surgical wards

Most of the patients knew what to expect from their stay in the medical or surgical wards because they had previously been admitted to the hospital. However, the nursing staff had not explained to one patient that a 'named nurse' had been designated to his care.

In general, the staff had explained to the patients the purpose for which tests or procedures were carried out. However, the staff had not ensured that a medical patient understood the explanation he had been given. Consequently, the patient was unclear about the type of procedure that he had undergone and the specific purpose for which it had been carried out. Some patients did not see any necessity for them to be involved in decision-making about procedures to be carried out and instead deferred to the doctors' judgement.

The purpose of new medications were generally only explained to patients when they were being discharged home. The explanations given by staff did not usually include details relating to the potential side-effects of medications.

The surgical patients were well-informed about their operations - what they would involve and how they would feel post-operatively - prior to these being carried out. However, post-operatively, a surgical patient was unsure whether he had cancer because, although the medical staff had explained the outcome of his operation to him, they did not clarify that he had understood the diagnosis.

In relation to patient privacy, a patient's wife had to ask for a discussion about her husband's care to take place in a private place, rather than in a hospital corridor.

Preparation for discharge from hospital

All the patients felt they had enough time to prepare for going home before they were discharged. The staff explained the patients' medications to them (the purpose for which they were prescribed) before they were discharged.

Some of the patients were given advice on self-care before they went home. Surgical patients were visited at home by the district nurse who assessed their progress. A minority of the patients did not know who to contact if they experienced any problems following discharge.

All the patients were asked if they needed any help arranged at home and, where this was needed, the care arrangements were always in place when the patients were discharged home. However, a female patient who was discharged home was unable to wash herself properly because she had been waiting two-and-a-half years for a bath aid to be inserted.

On discharge, each patient was given a letter to give to her/his GP. In addition, all the patients were sent details of outpatient appointments in the post. However, in some cases the patients had not been told before they were discharged whether they would be followed-up in outpatients. In addition, it appeared that the staff had arranged for a community social worker to visit a medical patient at home, but they had not informed the patient himself.

Other issues relating to the inpatient stay

The patients highlighted a number of issues where they had concerns: mixed-sex wards; male workers providing care to female patients; moving patients to other beds or wards; basic care provision; handling of death on the wards and witnessing abusive or violent incidents.

Conclusions

In general, the patients spoke highly of the Mater hospital and its staff. In addition, they were generally satisfied with the information that the staff provided. It was clear that, as a rule, staff communication with the patients was satisfactory and the staff sought to keep the patients informed throughout the duration of their stay in hospital. Indeed, the staff are made aware of the information and communication needs of patients generally, as the Chief Executive provides a guidance and information leaflet on communicating with patients to all new staff during their induction training.

However, the study has shown that, in a minority of the cases, staff communication with inpatients was ineffective for one or more of the following reasons:

If the communication had been two-way in these instances, then the patients would have been able to point out that they had not heard or understood what was being said. Consequently, whilst all staff are made aware of the communication needs of patients, good practice in communicating with patients needs to be made more widespread.

It should be noted that the information on tests, procedures and treatment which the staff provided was not always comprehensive. In addition, the potential side-effects of medications were rarely explained to patients. One patient had not been made aware that a 'named nurse' had been designated to his care. Some patients were not informed before their discharge that follow-up arrangements had been made for them. In addition, a minority of the patients had not told been told who to contact if they experienced any problems following discharge.

In terms of involvement in decisionmaking, the patients tended to have low expectations in this area - they did not expect to be asked for their views on treatment and they lacked the confidence to put questions to the medical staff. As the sample primarily consisted of older people, this age group tends to have lower expectations of health care than younger adults and they are more inclined to be deferent to doctors.

A number of issues were raised by the patients - other than information or communication - which highlighted concerns they had relating to other aspects of their hospital stays. Specifically, the patients mentioned negative experiences they had had which related to mixed-sex wards; male workers providing care to female patients; moving patients to other beds or wards; basic care provision; handling of death on the wards and witnessing abusive or violent incidents.