Hospital Stay Communication Guide
How to share any worries or concerns you may have about care
Learn Who’s Who in Your Hospital
Your loved one will have many care providers while in the hospital, especially if you’re in a large teaching hospital. It can be quite confusing! Knowing who’s who and the layers of responsibility and accountability can help you communicate effectively. The chart below shows the organization structure that’s common in a teaching hospital. Use this as a general guide as hospitals vary.
Medical Staff Chain of Command
DEFINITIONS:
Hospital Medical Staff
The number of hospital care providers interacting with your loved one can be confusing, especially in a large teaching hospital. You can download our checklist with definitions for reference during your hospital stay.
DOCTORS
- Attending Physician: Team leader responsible for all aspects of a patient’s care. (Might be someone’s primary care physician, surgeon, specialist or hospitalist.)
- Hospitalist: A doctor trained in internal medicine who only works with people who are hospitalized.
- Specialist: A doctor extensively trained in one area of medicine — heart, lungs, kidneys, digestive system, bones, etc.
OTHER Medical Care Providers (also known as “House Staff”):
- Teaching hospitals will have medical students on staff who are supervised by the attending physician.
- An intern has just graduated from med school as a fully-licensed doctor.
- Interns then become residents for one to six years depending on their area of medicine.
- A chief resident is in charge of all the resident doctors and reports to the attending physician.
- A fellow is a doctor who has completed residency and is in training for a subspecialty.
- A physician’s assistant (PA) has advanced training in diagnosis and treatment; works under the supervision of a doctor.
- A certified medical assistant (CMA) assists doctors with administrative and clinical tasks.
Download the medical staff definitions to keep handy during your loved one’s hospital stay.
NURSES:
- Nurse Manager: Senior-level Registered Nurse (RN) who is responsible 24/7 for the nursing staff and patient care on one or more units.
- Charge Nurse: A Registered Nurse (RN) who manages—for one shift—the nursing staff and patient care for a unit.
- Staff Nurses:
- Registered Nurses (RN) report to Charge Nurse or doctor.
- Licensed Practical Nurses (LPN) report to RNs and doctors.
- Nurse Practitioners are RNs with advanced training in diagnosis and treatment; they work under the supervision of a doctor.
- Certified Nursing Assistants help nurses with administrative and clinical tasks.
Good communication is key to good hospital care!
Use our guides on “who’s who” on the hospital care team and what they do.
This will help you identify those who can best help you with to any concerns about medical care during a hospital stay.
Examples: Some medical concerns to share…
- Error in diagnosis/misdiagnosis
- Medication side effects not explained
- Incorrect treatment, delay in treatment
- Poor explanation of treatment, poor communication
- Unsuccessful treatment
- Poor pain management
- Unresponsive or abusive medical staff
- Inexperienced medical staff, lost trust in care
- Poor/delayed patient assistance when needed*
*For parking, billing or any non-medical concerns, use the hospital website. Main entrance greeters can also direct you to appropriate staff.
Know who’s on your loved one’s medical team. It can change with every shift, so snap a photo of the white board in your loved one’s room or take notes with every staff introduction.
Confused about staff titles and what they do? Check out our “Who’s Who” on typical care teams.
A CONCERN
becomes a COMPLAINT when it is not resolved within 24 hours by the hospital medical staff.
A GRIEVANCE
filing against the hospital is the next step if a COMPLAINT is not resolved.
HAVE CONCERNS?
See five keys for effectively sharing your worries with the medical team.
A hospital has other trouble-shooters you can turn to if you have voiced your medical concerns to your loved one’s medical team—without resolution.
Despite your best efforts, is it time to file an official Grievance against the hospital?
Not feeling heard?
Make sure you follow these guidelines for effective communication with your loved one’s medical team.
Know Your Rights:
- Familiarize yourself with the patient’s rights and responsibilities usually provided.
- Understand the hospital’s policies on complaint resolution.
- Understand the difference between medical and non-medical complaints.
Write down the names of the care team including:
- Hospitalist.
- Charge Nurse.
- Specialists on your team.
- Discharge planner/social worker/case manager.
Confused about who’s who on your loved one’s medical team?
Effective Communication:
- Clearly express your concerns and observations in a factual manner. Try to leave emotion and blame out. Do your best to maintain a solutions-oriented approach.
- Help providers see your loved one and you as people, not “complainers” – you are more likely to be heard. (Show pictures of social life including family time and activities).
- Immediate communication is best in any situation you believe requires urgent attention. Share your concerns directly with the healthcare provider or the staff involved.
- Use specific examples to illustrate your concern/s.
- Maintain a calm and respectful manner.
Document Everything:
- Keep a record of the patient’s symptoms, changes, and any concerns.
- Note the names and positions of the healthcare providers involved.
Hospital Staff Who Can Help You With Your Concerns
Titles may vary by hospital, but here’s a general idea of other staff available
There are many on the hospital administrative staff ready to help you resolve your unanswered concerns.
Rapid Response Team (RRT)
- A clinical team with critical care experience that provides rapid assessment and treatment of patients who are acutely deteriorating or having a medical crisis.
- Individual hospitals often have their own rules for how a patient, family member, or advocate can call the team.
Case Manager/Social Worker/Discharge Planner
- Typically, a nurse who helps organize care needs and communicates with providers, patients and families.
- Provides patients and families information about resources to manage the emotional, financial, and social needs related to their illness.
- Coordinates discharge planning (assessing a patient’s ongoing medical needs when they leave the hospital and creating a plan to ensure patients are discharged to the most appropriate environment for any ongoing care needs).
- Performs utilization review (verifying a patient is receiving medically necessary care in the proper setting).
Patient Advocate/Patient Liaison
- Some hospitals use social workers, nurses, or chaplains to advocate for patients.
- Private professional patient advocates or medical navigators can help identify challenges in care and offer solutions (services typically extend beyond the hospital environment)
- May also help with medical billing issues, care coordination, and determine important questions to ask providers.
- Gather information regarding patient care issues and questions, evaluate patient well-being, and suggest improvements.
- May function as a representative for patients and their families to direct questions or complaints to appropriate healthcare professionals.
Patient Relations Ombudsman
- Reviews patient complaints in a hospital and serves as an intermediary between the patient and the hospital system.
Patient Experience Team
- Helps patients and families understand hospital policies and attempts to improve patient-centered care.
- Evaluates concerns or complaints about hospital care or services.
Patient Safety Officer
- Determines potential risks in a hospital system, designs policies to minimize the risk of medical errors, and investigates incidents while tracking overall trends.
Quality Management
- Often a team that reviews data such as patient outcomes, experiences, and adverse events following a hospitalization.
- Recommends modifications of policy to improve care in the future.
Risk Management
- Works to identify, assess, and reduce risks to patients, staff, and visitors.
- May work in areas related to patient safety, clinician quality improvement, legal compliance, medical claims, insurance, data security, etc.
Want to File an Official Complaint?
Here’s a basic chain of command which may vary a bit by hospital.
1. Know name of your Hospitalist or Attending Physician. (This can change daily/weekly.)
2. Identify the nurse in charge of the patient’s care. (This can change daily.)
3. Contact Social Worker/Case Manager/Care Coordinator.
4. Request Patient Advocate:
- Facility Patient Advocate or Independent Patient Advocate: Request the presence of a patient advocate.
- Patient advocates can help bridge communication gaps between caregivers and medical staff.
5. Involve the Patient Ombudsman or Patient Relations:
- Contact the hospital’s patient ombudsman or patient relations department.
- They can serve as mediators and help resolve conflicts.
- Request a Care Conference:
- Ask for a meeting with the healthcare team to discuss the patient’s care plan.
- Involve key healthcare professionals, including the attending physician.
6. Contact Hospital Administration:
- If issues persist, escalate the matter to the hospital administration(Contact Risk Management and Patient Safety/Quality)
- Provide a written summary of concerns and actions taken. (check the rights and responsibilities information – they may have a hotline to call)
7. Emergency Situations:
- In case of an extreme emergency or rapid deterioration of the patient’s condition, call for immediate assistance. Also known as Rapid Response Team
- Use emergency codes if applicable in the hospital.
8. Involve External Agencies:
- If needed, contact relevant external agencies, such as the state health department, regulatory bodies (i.e., local congress representative or The Joint Commission)
9. Seek a Second Opinion:
- If necessary, request a consultation with a specialist or another healthcare professional for a second opinion.
- Consider the option of a hospital transfer.
Ready to File an Official Grievance?
A hospital grievance is a formal complaint that you can file with the hospital if you are not satisfied with the care you received. To file a grievance, you will need to provide the hospital with your name, contact information, and a detailed description of your complaint. You should also include any supporting documentation, such as medical records or witness statements.
- The hospital will investigate your grievance and respond to you within a certain timeframe. The specific timeframe will vary depending on the hospital’s policies. If you are not satisfied with the hospital’s response, you can appeal the decision.
- For more information about filing a hospital grievance, you can contact the hospital’s patient advocate or patient relations department.
- You can also find more information online at the website of the Joint Commission, which is a non-profit organization that accredits hospitals.
