Of course all disciplines in the SNF should be telling the same story regarding a resident’s needs and care provided.  This is documentation and should remain constant across all shifts.  But Clinical and Care documentation is different than Communication.

Who’s On First?

Some of us who have a few rings around the old trunk will remember the old Abbot and Costello routine about “Who’s on First?”  It is a comical portrayal of communication at its worst.  

SNF Communications

Communication in the SNF can be a major challenge.  Communications between departments, disciplines, residents, family members and staff, all present their own issues.  

What solutions help to minimize potential miscommunication?

• Develop internal systems that support the processes.  
• If there is a morning stand up meeting, follow an agenda so that the same items are discussed and documented….daily census, admissions and discharges, key care concerns from the previous 24 hour period, etc.  
• Develop a form or a system to communicate information regarding new admissions.  If you use an integrated EHR, review the templates that are available for customization to help your staff communicate in an electronic format, minimizing the paper shuffle.  This will help to ensure that the needs of a new admission are met in a consistent manner with a resident/family feeling welcomed and supported.
• Use technology when possible.
• Just as the clinical record may be in an EHR format, is there a similar solution for the inquiry/admissions paperwork, the business office paperwork, etc. that allows for upload of scanned documents into one record accessible by staff according to their individual security permissions assigned?  It is time to let go of the old hard copy files.  All admission paperwork can be scanned and stored, uploaded into the EHR.  This allows quicker access in the event there is a need to follow up on any billing issues, re-admission reviews, etc.  And it saves space which is critical in some buildings.  Depending on the configuration of your EHR, it is possible to create customized management reports that capture information from the uploaded information.  For example, where are our inquiries coming from by physician, hospital, zip code?  What diagnoses are we not admitting?  Is this a new market opportunity for us?
• Consider providing cell phones to staff who are either outside of the building quite a bit or inside but not always in their office.  Clinical liaisons, Admissions reps, Nurse Practitioners, etc. can get calls in real time and respond quickly vs. trying to catch up on voicemails later.  There is no reason to lose a potential admission because a voicemail was not returned.  Can you provide a cell phone or cordless phone to the Nursing supervisor (it can be passed on each shift) in order that physicians and other providers can directly communicate with the nursing supervisor in a medical situation and not be left waiting on hold while a staff member tries to locate the nursing supervisor for a call back from the physician?
• Does your telephone vendor offer a software solution that allows you to retain the recorded phone messages into a record which could be used to verify that a call was made or received.
• Use software packages to handle eligibility/insurance verifications prior to admission and at least once a month as part of the billing process. Upload the results into the resident record.
• Use a tablet or laptop in meetings to record minutes or complete forms, templates, etc. that chronicle the events vs. having to go back and “write up my notes”.
• Communicate the most important information in three formats since all adults learn and process information differently.
• Written format
• Are policies, procedures, checklists, etc. in writing? Visual learners need to visualize the information.
• Make sure that the print style and font are large enough.
• Explain any acronyms.  We have so many in the healthcare field.  
• Verbal format
• Explain the information in a conversational tone and pay attention to clues that it is understood.
• Nodding of the head, eye contact, asking for feedback such as “Are there any questions?  Does this make sense?”
• Kinesthetic format
• Especially in a learning situation with staff, try to have an exercise or interchange that allows the recipient to get more engaged and demonstrate the knowledge.  Even with residents and family members, it might be as simple as “let me show you how to _____, now you try it.”
• In verbal communication… less may be more.  Keep the information brief and concise.  Need to know.  If you need a response, give a deadline or timeframe.
• In electronic communication such as email, remember your email etiquette.
• The person to whom the email is addressed is the only one expected to respond.  The CC: or Carbon Copy is generally considered as FYI and not expected to respond or act on the information.
• Be careful when addressing an email… BCC: or Blind Copy should be used when you don’t wish all recipients to see one another’s name or email address.  
• Use secure email to communicate any sensitive information.  You may also wish to involve your IT provider to help create web portals for your resident accounts and even FTP sites for contact who need to send and receive sensitive or PHI information on a regular basis.  HIPAA is watching.  The Office of the Inspector General (OIG) is launching new initiatives on HIPAA compliance targeting the LTC industry.

Communication is a two way street for sure.  However, in order for all parties to reach the same destination of understanding, keeping it simple and using technology when possible are the best solutions.