Patient Information Handbook Suggestions
One of the things we do at Manziel Law Offices, PLLC is review forms for medical providers. Although our reviews generally focus on admissions and financial forms primarily from the perspective of minimizing problems that often lead to claim denials or difficulties obtaining proper payment, we have occasionally reviewed other types of documents and we have obtained extensive practical knowledge from decades of working with and providing on-location training seminars for health care providers.
One of the documents commonly provided to patients by institutional providers is a Patient Information Handbook (referred to below as “PIH”) to help patients and their families feel comfortable by knowing “the lay of the land” and “how things work”.
It is often the case that a Provider’s PIH was written years ago and has rarely been updated. A modern PIH should consider everything from an “Internet Age” perspective.
- Internet Age Update:
- Does the PIH include email addresses?
- URL for the overall hospital website (including on both the front and back covers)
- URL for the hospital’s Facebook page
- URL for the hospital’s Twitter account
- URL of the community-interaction events calendar
- Email or URL to on-line form to sign up for hospital’s community email newsletter
- Web contact information for various departments (emails, phone)
- URLs of any departments with their own Facebook page
- Web information for physician groups, clinics, etc., associated with the hospital
- Web information for general information (press releases, media inquiries, etc.)
- Web information for major health information sources and programs such as CMS, Health Exchanges, Medicare, CHIP, STAR, Medicaid, Tricare
- Trauma Certification: Does the facility have a Level 1 or 2 Trauma Center certification or participate in a regional trauma program? If so, consider explaining the services a Trauma Center offers that are not available at non-TC hospitals and including links to information about trauma care and trauma such as:
- Trauma Center Association of America (www.TraumaFoundation.org)
- National Center for Trauma-Informed Care (www.samhsa.gov/nctic)
- Web-based Interactions: Information should be included on how to do activities now commonly done through the Web, such as :
- Make payments
- Schedule appointments
- Obtain copies of forms that will need to be filled out
- Obtain email or text message notification about test results, births, etc.
- Request or provide information
- Local Amenities: A regional facility should include a list of nearby amenities such as restaurants, hotels, motels, RV parks, short-term apartment rentals or extend-stay hotels/motels, auto rental companies, religious congregations, and shopping malls.
- Facility’s Local Ties: Sometimes a Provider may have special ties of local interest. For instance, it may be the primary hospital for a nearby military base or for a national or state park or major tourist attraction such as Six Flags and often treats vacationers. Does the Provider have any services, liaisons, etc., particularly for that other entity’s personnel and their relatives? If so, consider mentioning those, and if not, consider implementing some.
- Crime Avoidance: Patients with an admission for more than a few days may overlook matters that are not specifically medical. The PIH should point out that mail piling up in a mailbox, multiple newspapers on a lawn or doorstep, advertising flyers remaining on a door several days, an unkempt lawn, a car sitting in a driveway day after day, and/or a house with no lights on night after night can attract burglars or persons stealing mail for identity theft.
- Crimes Against Visiting Relatives: The PIH should point out that the “empty home” issue can also apply to the homes of out-of-town relatives visiting to help the patient. Note: the “empty home” warnings for patients and for relatives should be in separate paragraphs because many people skimming a handbook will read just the first few words of a paragraph and move on.
- Dangerous Neighborhoods; Gangs: If the facility is located in or near a crime-prone area, the PIH should mention fairly clearly that patients and relatives are advised to avoid certain neighborhoods for their own safety and they should ask Provider personnel for specifics. Similarly, certain gestures or color combinations may be associated with local gang activity.
Caregivers / Pastoral Services / Visitation
- Caregiver Team: A section describing the various types of caregivers should specifically mention and explain hospitalists. Patients or visiting relatives could feel uncomfortable with minimal or non-existent interaction with the patient’s usual physician and might feel they have been “handed off to a bunch of strangers”.
- Pastoral Services: Most people don’t realize that the HIPAA Privacy Rule regarding confidentiality of Protected Health Information prohibits hospitals from automatically informing local religious congregations of admissions. Admission forms often do not ask about permission to contact a local congregation. Patients or family members sometimes are disturbed when no one from their congregation visits. Add something to the effect that upon requestthe Hospital will notify your congregation so they can visit.
Also, many people equate “chaplain” with “Protestant/Catholic” or “Judeo-Christian” and are concerned a chaplain will be condescending or otherwise insensitive to persons with other beliefs. Consider adding something to the effect of “accustomed to dealing with the general public”, “sensitive to the variety of religious beliefs”, or similar language.
- Patient Visitation: Review policies for step-children and non-traditional arrangements such as in-household children of a “life partner” or unwed couple; nieces, nephews or cousins the patient is raising; and grandchildren who are members of the patient’s household because the children’s parents either are not around or have moved back in with the patient. The patient could easily have an emotional attachment to such children essentially the same as a parent-child attachment.
- Visitation Rules – Electronics: Are there any restrictions for visitors on the use of cell phones, texting, iPad or other tablets or similar electronics? How about cell phone cameras? Conversely, are public wi-fi, electrical outlets for laptops and recharging electronics, or similar conveniences available? If so, where?
Availability of Communication Electronics
- Patient’s Electronic Communications:
- Patient cell phone usage (calling/receiving)
- Patient texting (sending/receiving)
- Use of cell phone cameras
- Is in-room Web access available?
- Is in-room email available?
- Video chat such as Skype
- Is VOIP (Voice Over Internet Protocol) available so patients can talk long distance without running up massive phone bills?
- For patients who don’t have access to a wi-fi enabled laptop, is there someplace they can go and use a supplied computer to surf the Web, send and receive email, do Web-based banking or make Skype video calls?
- Medical Orders re Electronics:A related medical issue is do standing orders or physicians’ orders address whether a patient should be prohibited Internet/texting (etc.) access or allowed limited or unlimited access?
Although that is not primarily a handbook issue, the PIH might mention that sometimes standing orders or individual orders may relate to a patient’s Web access and use of electronic communication devices.
- Television: What programming is available, i.e., local air channels only, Spanish, expanded cable, pay-per view? Is radio available, possibly including Sirius XM, Pandora and/or Internet radio?
Other Common Concerns
- Periodic Payments: Particularly with unanticipated admissions or admissions that last longer than expected, does the patient or visiting relatives have any payments upcoming that cannot be delayed, such as apartment rent or a car loan payment?
- Patient’s Care for Others: In addition to emergency admissions and urgent admissions, people facing major surgery, etc., often are distracted and may not think to make necessary arrangements for other matters, e.g:
- Does the patient have pets that will need to be cared for?
- Is the patient a caregiver responsible for children, a parent, or other person?
- Does the patient routinely check on someone else such as a neighbor who lives alone?
- Does the patient periodically perform an activity for someone else such as picking up medicine or driving the person to a doctor visit?
- Organ, Tissue, Blood Donors: Since it is unlikely only the patient will see the PIH, consider mentioning somewhere that information is available regarding organ, tissue or blood donor registration.
- Discharge Instructions: Sometimes, particularly with admissions involving “patient unable to sign” admission forms, lack of complete signatures or information can cause problems filing health insurance claims, auto liability insurance claims, etc. It should be a simple matter to examine financial responsibility forms before discharge and just indicate, “we’ll need you to complete some paperwork for your discharge.” Although technically that does not involve “Discharge Instructions“, a sentence in the PIH making “completing discharge paperwork” sound like a routine part of discharge can help.
On-line and CD Handbook
- On-line PDF Patient Information Handbook: The PIH should be available on-line in PDF format, most likely as part of a larger “informational package” developed primarily from a marketing and public relations viewpointrather than as a separately downloadable document.The Web-based PDF could include hyperlinks to more detailed on-line information such as a directory of departmental phones and emails.
- CD Version: Consider putting the PIH and other information on a CD and either including that with the PIH or noting in the PIH that a CD version is available upon request. (Particularly in rural areas, many folks may not have access to high-speed Internet.)
- Provide PIH CDs to Physicians: Copies of the PIH CD version could also be provided to physicians who regularly admit patients for them to give out. CD duplication with labels but no paper sleeves starts at around 50 cents each in 1000-copy quantities and sleeves are around 5 cents.
- PIH Update Coordination: Note that if Web, PDF or CD versions are available, there needs to be a procedure to automatically coordinate all versions when a change is made.
Covering the Cost of CDs and Handbooks
It might be possible to offset some of the cost of the CD PIH and/or to develop goodwill by selling or giving free advertising/listings on the CD version to various area physician groups, rehabilitation facilities, Skilled Nursing Facilities (SNF), Long-Term Acute Care (LTAC) faclilities, etc.
If the PIH includes information on Local Amenities, minimal charges for a listing could pay the entire cost of preparation and duplication. Hotels, motels and vehicle rental companies might even be interested in keeping CDs on-hand for customers whose relative is being treated at the facility.