Posted April 05, 2016

Patient Communication that Builds Trust in Advanced Practice Providers

By Josh Kosowsky, M.D., FACEP

Over the past two decades, advanced practice providers (APPs) have been growing both in sheer number of jobs and in their importance to the delivery of healthcare. U.S. labor statistics estimate that more than 90,000 physician assistants and 122,000 nurse practitioners are practicing today with growth rate estimates ranging from 33 percent to more than 50 percent over the next decade.i

Healthcare reform continues to drive demand for APPs, not just in primary care, but across all inpatient and outpatient specialties as organizations respond to the convergence of physician shortages, cost reductions and increased demand for services.

While healthcare organizations are expanding the roles of APPs, patients' understandings of these roles has not evolved as quickly. As leaders, we can't afford to wait for public perception to catch up. It's up to us to manage patient expectations, and in turn the patient experience, by leveraging proven communication techniques.

Nowhere is this more true than for APPs practicing in the emergency department (ED) setting. While the scope of practice for a nurse practitioner or physician assistant will vary depending on the ED, APPs play an increasingly significant role in emergency departments big and small, rural and urban, academic and community-based. Whether performing advanced triage, providing fast-track coverage, overseeing an observation/clinical-decision unit, or seeing patients alongside physicians in the main treatment area, APPs have become ubiquitous to the point where at some EDs the average patient is more likely to have contact with an APP than with a physician.

Structuring the right mix of physicians and APPs in the right roles is part of mastering efficient patient flow, a characteristic of all high performing EDs. See Five Ways to Diagnose and Treat Your Emergency Department.

Because they often tend to see lower acuity patients, APPs have an outsized impact on the perceptions of patients who end up being discharged from the ED. And it is those discharged patients who will receive the Emergency Department Patient Experiences of Care (EDPEC) survey. Because survey questions place an emphasis on the quality of communication with providers, we need be sure that our APPs are well versed in tools and techniques such as AIDET® (Acknowledge, Introduce, Duration, Explanation, Thank You).

How can APPs make patients feel confident they are in good hands?

For a lot of patients, there is confusion and apprehension around the role of APPs within the ED care team. The AIDET® framework is proven to reduce patient anxiety and build trust with patients. In particular, AIDET® is important for APPs when it comes to "I" - Introduction.



Provider smiles and greets the patient and family members/friends in the room.

"Good evening, Ms. Jones. Who is here with you today?"



"My name is John Smith. I've been a physician assistant - or PA -in this Emergency Department since 2012. I'll be the provider taking care of you today.

If working alongside a medical doctor, either directly or indirectly, the PA would continue:

"I'm working with a fabulous team, including Dr. Meltzer, the attending physician on duty today."



"Dr. Meltzer will be in to see you after we have your x-ray results. Typically, that takes about 45 minutes."



"I want to be sure we're not missing anything, so I'm going to review your case with Dr. Meltzer and ask him to come take a look at that rash".


Thank You

"Thank you for trusting us to care for you."

In a less careful introduction, a patient might hear "nurse practitioner" and think "nurse," or, in the case of a physician assistant, they might hear "physician". In either instance, this confusion can impact the patient's perception of care of their entire visit. For example, it is not unusual to read survey comments from EDs that utilize APPs, where patients complain "I was never seen by a doctor" or "there were different doctors coming in and out of the room, but I couldn't tell who was in charge." These anxieties can influence a patient's overall perception of care even when their experience has been excellent in every other area.

With the increasing prevalence and expanding roles of APPs in ED settings, their impact on patients' perceptions of care will continue to grow. Focusing on key words for APPs, particularly around how they are introduced, is something you can start doing today to make a difference for your ED and for your patients.

Dr. Josh Kosowsky is coach on Studer Group's Emergency Department Services team. He is Vice Chair and Clinical Director of Emergency Medicine at Brigham & Women's Hospital in Boston and holds an appointment as Assistant Professor of Emergency Medicine at Harvard Medical School.

Additional Resources:

  • Find more insights for the Emergency Department by filtering for the ED Strategies blog category.

Learning Lab Resources (exclusively available to Studer Group partners):

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iBureau of Labor Statistics http://www.bls.gov/oes/current/oes291071.htm and http://www.bls.gov/oes/current/oes291171.htm


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