Phone etiquette for medical staff.

This seems like a pretty obvious topic, but it is one of the things that really pushes my buttons. When you ring a ward or service to get some important information, and the person on the other end picks up the phone with a busily-annoyed “YES?” or simply “He-llo?”.
Am I talking to a nurse? A dietitian? A cleaner? Am I through to the right ward?

Lets take a look at some simple but often forgotten telephone etiquette, specific to the information overload environs of the hospital.

When making a call.

1. Plan the call: before you even pick up the phone, take a second to rehearse your call.
   Distill down everything you want to say, cut off the fat, the crap, and the faff.
   Remember the person on the other end may be even more busy than you are. Help them to help you.
2. Consider SBAR: To help you organise your thoughts, particularly when communicating patient information, you might like to consider the acronym SBAR ( Situation, Background, Assessment, Recommendation). You can download this pdf prompt card to help you remember.
   1. Situation:  Identify yourself as below. Describe reason for your phone call
   2. Background:  Give the background to the issue. If talking about a patient include: presenting complaint. any relevant past medical history, and a brief summary of the background to the current issue.
   3. Assessment:  Include, assessment of ABC’s, vital signs – HR, RR, O2sats, BP, Temp, AVPU. Your assessment of the severity of the patient, and any additional concerns.
   4. Recommendation (or your plan). Explanation of exactly what you require, how urgent and when action needs to be taken.  Make suggestions of what action is to be taken, and clarify what action you expect to be taken.
3. Introduce yourself. When the person on the other end answers, introduce yourself and state your role and area.
   “Hello, this is Ian Miller calling, I’m the chief executive of Bongo Healthcare and I would like to speak to Dave Hogan please“.
4. Make your call: once the call has begun, use the same tips as when taking a call.

When taking a call:

1. STOP: I have talked about STOP before. And answering a telephone is an exceptionally useful place to practice this. Let the phone ring 3 times whist you prepare.
2. Focus your attention on the caller: Do not try to continue those other 3 simultaneous conversations, as well as stuffing that last chocolate left over from night duty down your gob, and performing CPR whilst using the phone cord as a tourniquet.
3. Engage your phone voice: Most telephone conversations in the hospital are going to involve communication of important high-value information¹. We want to place this conversation in an environment that will optimise the quality of communication. So…
   1. Take a deep breath from your diaphragm before you begin to speak.
   2. Smile. This changes everything.
   3. Make a conscious effort to slow your speaking pace down from your normal speed.  And drop your voice a semi-tone. This can feel quite awkward and even artificial,  but makes a huge difference in clarity to the person on the other end of the line.
4. Answer in full: When someone calls, they want to know straight away if they are speaking to the right person in the right place²
5. Do not just say hello. Give your greeting. State the area you are working in, your occupation³, and your surname. If you are working in a key position, for example, unit manager, you should state that too.
   So. *Smiles* Good afternoon. Emergency Acute Care… Nurse Miller speaking.
   Or perhaps. *Grins* Good morning. Emergency Department, unit manager Nightingale speaking.
6. Listen: Take in not only what the caller is saying, but see if you can pick up on any non verbal cues as well.
7. Be prepared: to write stuff down.
8. Seek clarification:  If the caller is giving you important information, reflect your understanding back to them.
   Copy that⁴……Mr Bradfield’s ward allocation has been changed from 11B to 10A.
9. Take ownership of the call: If you are going to transfer the call to another extension, tell the person where you are going to send them and if possible give them a ‘plan B’ in case the call is lost (eg give them the number for the main switchboard, or take their number so you are able to call them back).
   If the person states that they have already been transferred a gobzillion times….try not to transfer them again. Instead, get their contact number so you can find the appropriate person and get them to return the call.
   If you are going to put them on hold, assure them that you are going to find the person/information and get back to them. Give them a realistic idea of how long this might take. Don’t just say “Im going to put you on hold” or “I will just be a sec”.
   If you are going to find the person for whom the call is intended, find out who the caller is: “May I ask who is calling please?”

Patient inquiries:

This is a whole topic in itself. But remember, you basically have no way of knowing for sure who it is on the other end of the phone, so the information that you can give out with respect to any one of your patients is minimal.
Talking from personal experience here, I can warn you to be very careful with these calls.
Depending on the patients actual condition, perhaps you can say something like this: “Mr Jones has had a comfortable night and remains in a stable (or unstable, or critical) condition.” This really isn’t saying anything of much use to the caller but is probably about as far as you dare go.
I would add “ Im sorry but I’m sure you appreciate the need to maintain Mr Jones’s privacy. That is all the information I am able to give you at this time…I suggest you contact her mother (or other contact) for more information.” But, of course, dont give out any contact numbers.

During your care of your patients, make sure you have strong information pathways in place with the significant people surrounding them. Get a primary contact number and let everyone else (family, friends etc) know that this person with be the go-to for them to get updates etc.
And then make sure you have an alternate contact as well.

1. mind you, you must also deal with plenty of calls that will take up a significant amount of your time just trying to sort out stuff that has absolutely nothing to do with you [↩]
2. and it is useful to remember that they may already have been transferred from pillar to post before ending up on your line [↩]
3. you don’t need to get all caught up in full titles….just say nurse [↩]
4. you don’t have to say “copy that”, its just one of the many drooby things I say all the time [↩]