AIDET Builds Patient Loyalty and Volumes
with CNO Kate Cronin, ED Medical Director Dr. Harneet Sethi, and Nursing Director Cheryl Pinney, Cheshire Medical Center/Dartmouth-Hitchcock Keene Emergency Department, Keene, NH
In early 2005, Cheshire Medical Center/Dartmouth-Hitchcock Keene Emergency Department (an ED with 28,400 annual visits in Keene, NH) was ranked in the 10th percentile for patient satisfaction with almost three percent of ED patients leaving without being seen (LWOBS).
Fast forward to December 2009: patient visits are up 31 percent since those days, while LWOBS has dropped to 1.3 percent. Since the ED introduced AIDET, bedside report, and nurse leader rounding, in 2007, a surge in new patients has resulted in more than $2 million in additional revenue2. Patient satisfaction has skyrocketed to the 94th percentile as measured by the competitive New England Peer Group and 96th percent nationwide. And in spite of this large increase in patient volumes, the ED kept door-to-doc time stable, at an impressive average of just 41 minutes, and a stable turn around time of 181 minutes for treat and release patients with no increase in staff or beds! How'd they do it?
AIDET Gets Results
The ED created a patient-centric model that created strong word of mouth and loyalty in the community. One key tool in effecting the change was the use of Studer Group's Five Fundamentals of Service, otherwise known as "AIDET", which stands for Acknowledge—Introduce—Duration—Explanation—Thank You.
"AIDET are powerful key words we can use to improve patient perception and experience," explains the ED's Studer Group Coach Julie Kennedy-Oehlert, RN. "AIDET reduces LWOBS because patients who are informed about the wait are more likely to stay and receive the treatment they need. And it reduces patient anxiety while creating a relationship with patients that can improve their compliance with plan of care."
"Initially, the ED team began by acknowledging the patient and introducing themselves, but staff were uncomfortable about giving a duration for tests and procedures in case we made promises we couldn't keep," explains CNO Kate Cronin. "But we were surprised. By giving wait times and updating patients when and why it took longer, we got great feedback which motivated us and created a positive cycle of change."
Since the ED knows that it will typically hold chest pain patients for six hours, for example, staff can let patients know ahead of time and use key words to connect to why (e.g., "It's important to stay to ensure your health is not in danger.") Now patients will stay while a friend or spouse runs an errand or lets the dog out.
"What's most valuable about AIDET is that it provides a concrete framework for high quality patient interactions," explains Dr. Harneet Sethi, ED Medical Director. "We can train staff in these competencies specifically instead of just telling them to ‘be nicer.'"
Another hurdle the ED overcame: "Initially, staff didn't want to move their badge to shoulder height," explains ED Nursing Director Cheryl Pinney. "Registrars asked why patients needed to know their names. But it quickly became apparent to all of us that patients felt more valued…especially when we asked the names of visitors and family members. Suddenly, staff weren't hiding behind nurses anymore."
The ED team at Cheshire Medical Center/Dartmouth-Hitchcock admits that hardwiring takes rigorous accountability. "Shadow staff so they see you do it," recommends Pinney. "And follow up with patients to validate it's happening. When you say, ‘Mr. Jones in bed 11 has no idea what your name is. Did you use AIDET?', staff understand it's a priority."
Cheryl Pinney's top tip? "Don't give up! This requires persistence and true buy-in from leaders, particularly physicians. It can't be something that only nurses and registration staff do in the ED. We regroup and refocus after a bad shift. Every patient gives us another opportunity to get it right."
2 $2,036,100 new revenue is based on an additional 6,787 patients over three years at an average treat and release rate of $300.
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