To help the program operate smoothly on the frontline—when the calls come in—Shadyside Hospital initially developed a decision tree for operators answering Condition H phone calls. "It's very simple, and we've shared it with many, many hospitals," Liberi says. For serious clinical concerns, such as difficulty eating or breathing, a rapid response team would be summoned; for complaints about food or room temperature, a patient relations specialist would be contacted.
When Shadyside started Condition H, concerns were raised about whether the nursing staff would feel threatened by introduction of a program that encouraged patients and families to call if they had problems. But Shadyside and subsequent hospitals that have adopted Condition H have developed education programs for staff at the beginning to show how it fits in with their organizations' goals.
At Pepin Heart Hospital, a member of the three-hospital 575-bed University Community Hospital in Tampa, a video about the story of Josie King is played over and over again, says Amy Patterson, RN, BSN, who is the associate patient care services officer. It gets to the point where "people will not argue when you say we're doing this because we want to provide the best care."
Like other programs across the country, the call numbers are low—about a dozen in the past year—but there are advantages to keeping the program. One is that it addresses in part the 2009 Joint Commission's Hospital National Patient Safety Goal of identifying ways in which a patient and his or her family can report safety concerns.
While her organization has not experienced a case as serious as Josie King's, Patterson says it's important to keep Condition H as "an avenue that provides the family with a feeling of safety that they have someone to call ... and to have a place to say, 'I need help' or 'You're not listening.'"
Condition H also does not have to be confined to just inpatient uses. Shands HealthCare, which includes eight hospitals in Florida, has used Condition H among all its facilities for over a year, says Deborah Robins, RN, who is Shands' patient safety officer. This year, the program attracted the attention of its multispecialty physicians group associated with the University of Florida in Gainesville.
A vice president with the physicians group heard of the hospital initiative and wanted to try it in a clinical setting. "Sometimes someone does get distressed in an exam room or they are wondering what is going on," Robins says.
The group had some obstacles to face—mainly no phones in the exam room or rapid response teams to address their concerns. Instead, they used signs in the room to encourage patients or their families to open their doors and seek immediate assistance if necessary.
"It's not so much a dedicated hotline in that setting as it is empowerment of their customers, their patients," Robins says. "It lets them know that it's OK if you're concerned or you're feeling worse. Just open the door and come and get us."