Condition H phone line provides last chance to prevent serious errors
Family or patient can make emergency call if no one will listen
The idea of a Code Blue is well ingrained in hospitals. When the designated team hears that page for cardiac arrest, they drop everything and go running to help. Now one hospital has adopted a similar system for patients and family who fear something is seriously wrong but can't get any staff around them to help.
Called "Condition H" for help, the system at the University of Pittsburgh Medical Center (UPMC) Shadyside is designed to avoid or mitigate medical errors, says Tamra Merryman, RN, MSN, FACHE, vice president of the Center for Quality Improvement and Innovation for the UPMC Health System.
The system works this way: Patients and family members are taught on admission that if they ever feel that the situation is desperate and they can't get anyone around to listen to their concerns, they can pick up any phone in the hospital and dial 3-3131. When the operator picks up, the caller requests a "Condition H" and then that page is sent through the hospital's public address system. Several designated team members respond immediately, usually within a few minutes, and address the caller's concerns. The system works 24 hours a day, seven days a week.
The Condition H program was prompted by the death of Josie King, an 18-month-old girl at Johns Hopkins Hospital in Baltimore in 2001. The girl's mother, Sorrel King, has become a prominent advocate for patient safety and says the option to call a Condition H would have saved her daughter's life. The phone system is also known as "The Josie King Call Line."
At the most recent meeting of the American Society for Healthcare Risk Management (ASHRM), Sorrel King told her story and explained that she knew something was wrong with her child but that her concerns were dismissed by the staff and physicians. The errors that killed her daughter were easily correctable, but there was no system for Sorrel King to take her pleas to the next level.
"I know Condition H would have saved Josie's life," she says. "There is no doubt about it."
Rapid response team needed
Merryman heard King tell her story at a patient safety conference and realized that the bereaved mother had revealed a major flaw in the way hospitals operate. People have become accustomed to being able to pick up the phone and call 911 for immediate help everywhere except in a hospital. When you or your loved one is hospitalized, you are dependent on those around you to respond, and if they don't, you usually have no recourse.
She realized that families should be able to call a rapid response team when they are concerned and contacted Sorrel King last April to devise a plan that soon evolved into Condition H. Merryman found out quickly, however, that the idea was a radical one in the health care community. When she first approached her vice president for medical affairs, "he looked at me like I had lost my mind," she recalls.
Like many people hearing the idea for the first time, he feared that patients would abuse the system to complain about cold meals and grumpy nurses. That was a legitimate fear, Merryman says, because the Condition H system would be useless if it was overused and staff didn't take the calls seriously.
Merryman and Sorrel King worked with Richard Kidwell, JD, who had just recently joined UPMC Shadyside as director of risk management and associate counsel, coming from Johns Hopkins. At Johns Hopkins, Kidwell had worked with Sorrel King after the death of her daughter. Together, they created the Condition H program and piloted it on a medical/surgical unit at UPMC Shadyside. They introduced the idea to patients and family by explaining that they can call the rapid response team not for everyday, minor complaints but rather for two dire situations:
- If the patient is deteriorating clinically and no one is listening to their concerns.
- There is a communication failure and you don't know where to go with your concerns.
The pilot program was launched in May with good results, and Condition H was introduced throughout the hospital last July. By the end of the year, there had been six Condition H calls in the hospital, roughly one per month.
To educate patients about the Condition H program, all patients receive a brochure at admission. The front of the brochure has a picture of Josie King. (See excerpts from the brochure.) The hospital also uses signage in patient rooms, stickers on the telephones, and it is introducing a video message hosted by Sorrel King on the hospital's in-house television system.
Good patient education is key to making the program work and avoiding false calls, Merryman says. "If people misuse the system, that means we haven't done our job in educating them about why the system is here and how to use it," she points out.
Speaking from the family's perspective, Sorrel King says she is certain that patients and family will not abuse the Condition H system. "When they see that it is named for a little girl who died because people wouldn't listen, they're not going to complain about bad hospital food," she says. "At the same time, though, the nurses, staff, and physicians know they have to listen or it could go to a Condition H."
Not seen as a negative
Management at UPMC Shadyside encourages unit directors not to see Condition H as a failing by the staff and respond negatively when one happens. Instead, unit directors are encouraged to see a Condition H as a learning experience.
"You don't want staff thinking you're going to snap their heads off if the family calls a Condition H," Kidwell says. "It's true that a Condition H means things weren't going as well as they should have in some respect, but that doesn't mean that it's time to blame the nurses on that unit."
Each Condition H call is analyzed by Merryman and her colleagues to see what can be learned from the experience, Merryman says. In one call, for instance, residents learned about how important it is to go over the pros and cons of medical procedures without glossing over the patient's concerns. The patient had felt that the doctor did not adequately consider her fears and called a Condition H, so the hospital used that as an opportunity to teach medical residents about how a patient's particular background with medical care can create unique concerns that must be addressed.
Kidwell says the Condition H program should reduce the risk of liability from adverse medical events, but he stresses that reducing lawsuits should not be the real motivation. Empowering patients and family this way will improve patient safety by adding another chance to step in before a tragedy, he says. "It does help the staff ramp up their game a notch with a little extra communication and paying attention to the family."
Sources
For more information on Condition H, contact:
- Richard Kidwell, Director, Risk Management and Associate Counsel, and Tamra Merryman, Vice President, Center for Quality Improvement and Innovation, University of Pittsburgh Medical Center Health System, 5230 Centre Ave., Pittsburgh, PA 15232-1381. Telephone: (412) 623-2121.
- Sorrel King. E-mail: [email protected].
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