For Neurodiagnostic professionals, we all know how challenging it can be to get patient compliance for a routine test in the clinic or at the bedside. There are always those patients that will not comply even for a 30 minute routine test. Imaging sending the patient home for 1 day up to 4 days and get them to be compliant with remote testing protocols. For most of us, it is a constant struggle throughout every shift.
Why?
This is the question we all want to know the answer to. Patients will be on board in the office getting set up, agreeable to all the education the office provides and even at the check in to send them home. Then something happens when the patient leaves the office. We will get back to this later.
Let's talk about having a Long Term Ambulatory EEG and what that is really like for the patient. Even though having an EEG is non invasive, its still uncomfortable. Prep scrubbing, 10-20 paste ( sometimes stinky collodion) and wires all over the place. Then a tight headwrap and now you have a long leash of wires attached to your head all leading to a bag that you now have to carry everywhere with you. While you know it's non invasive and you agreed to do this, you now have a headache, an ugly purse and equipment you have to take home and plug in. Most of the time there are cameras to plug in at home and everyone is on edge in the house feeling like they are on a bad episode of a reality show. Now the reality of what this test requires in your home starts to hit as you walk out of the office with your equipment. Hind sight is always 20/20!
I think this is where the "Why aren't patients' compliant?" question comes in. Now you have all this stuff on your head with a new purse and the equipment loaded in the car. Now it hits, "I can't leave home for the duration of this test!" and this is where I feel most patients go a stray from the testing plan. Suddenly they remember all the errands that HAVE to be done before they go home, or that place they want to go eat and yes, we have even heard of patients going to a movie before going home! In most cases I feel like patients don't fully understand the education the office gives them until the reality of the test is actually started. This isn't the case for all patients.
While the benefit is being able to be in your own home and not trapped in a hospital room for this test, it's starting to feel like it may be more than you bargained for as a patient. Working remotely with this population has given me a greater insight to how important the patient care is in this remote role. Patient care is not just about the test but how the patient complies with the testing. The remote technician plays a very special role in this environment.
Patient Education is key. While we cannot control how much (or how little) education the office gives, we can ensure we provide the best education we can in our remote role. As an R.EEG.T. I have learned that gaining a patients' (and or caretaker's) trust is pivotal in the success of your test. This remains to be true in the remote monitoring world. Now the question is how do we gain trust in this remote environment.
Gaining trust starts with patient contact. In my personal experience, if you can get them home and gain contact, we can start building trust. Here is my method of gaining trust:
Build a rapport with the patient or caretaker. Speak to them at their level.
Educate them on what to expect and why we need it. The cameras are for the physician's review and why we need them to stay on camera.
Ensure the patient's privacies. You can cover or turn the camera away when changing or needing a few minutes off camera. No one needs cameras in the restroom! Be sure to remind them to uncover or turn back into view when finished.
Take your time on the initial home set up call. Do not rush and be sure the patient understands that this is often the hardest part. If we can get the equipment set up right on that initial call, the less likely we are to need to bother them during the duration of testing.
Answer all their questions as best you can in your scope of practice. If you don't know the answer, assure them you can find out. Set reasonable expectations on turn around time for a response.
FOLLOW UP! this is critical to gaining trust. If you have set an expectation for patient communication, follow up. Make sure the patient is followed up with even if it crosses into the next shift. NEVER leave a patient wondering who or when and even if they are going to get an answer to their questions.
Empower the patients and their caretakers by making sure they know how to contact the monitoring team. In my case, we have staff on 24 hours a day. While they may not be able to reach me directly at all hours, they can reach someone who can help.
We all know that there are times when it doesn't matter what we do, some patients will be non compliant. That is out of our control. While this is certainly true, I do believe we can minimize this as remote technicians. We can elevate our patient care by simply taking the time to talk to people and help them understand what we are doing and how this helps them. Remember one thing, you determine the patient care you deliver, no matter what the patient situation is.