Why You Need a Passport in the Emergency Room
By Pat Mastors, Planetree Patient and Family Partnership Council Member
Last week, I found myself heading to the hospital emergency room to meet up with my 83-year-old mother. She was being rushed there by ambulance after complaining of intense leg pain and heart palpitations. Within a reasonable time she was settled, stable and pain-free, with immediate danger seemingly averted.
Fortunately her hospital is part of a system where all of her medical records can be accessed with the click of a mouse. Still, a parade of care providers, one after the other, came into her treatment bay with the same litany of questions. What medications is she on? Does she have any allergies? When were her surgeries? Does she live alone? Does she prefer to be called by her first name? Does she have a signed DNR (Do Not Resuscitate) order?
Now, I realize repetition can be good; it sometimes uncovers mistakes. But surely a summary of her surgeries, for instance, should be recorded somewhere. As mom grew frustrated answering these questions over and over again, I started to supply the answers. And I thought, there must be a better way.
And there is. It’s called a “Patient Passport”– a new tool that, like a travel passport, contains a person’s essential medical information and treatment preferences. It’s all recorded in the patient’s/family’s own hand, (with guidance as needed from the primary care physician’s office), in a few simple and thoughtfully designed pages. Triage? Find critical information on the first two pages. History? Next two. My medication list is stored in the front pocket; my end-of-life info and notes from my last hospitalization, in the back pocket.
The Passport was developed just this year by the Patient and Family Engagement Action Team, a 17-member multi-stakeholder group, convened by National Quality Forum. I had the privilege of acting as Patient Co-Chair, along with Susan Frampton, President of Planetree. We started by reviewing other Passports already in use, primarily developed for special needs and pediatric populations. Together in one room, we ripped these samples apart and literally cobbled together a version, supplemented with our suggestions, with the intent of serving the broadest possible range of people in care. Among our team members, ER docs weighed in on what information would best help them triage a patient. Patients and nurse managers ensured the patient’s dignity and preferences were honored throughout. Hospital administrators created a supplemental “tool kit” to help an organization roll out the Passport to staff, to make the facility “Passport-ready”. (One great idea involved first having staff members fill out the Passport as a get-acquainted and trouble-shooting exercise). In the end, the little book is designed not to replace the medical record, but as a patient-directed overture to communication and “personalization of care”, to be shared with all one’s care providers. Couldn’t hurt that it serves as a patient-ported “constant” from office to office, specialist to specialist.
I went through this entire creation process with my own mom top of mind; after all, she is the quintessential “Passport Patient”, who is elderly, takes several medications and has a complicated medical history. And here’s the irony: even as we got mom through eight hours of tests in the ER prior to her being admitted for blood clots in her legs, I actually had a blank Patient Passport tucked in my purse. My friends at Planetree had sent it at my request, so I could pass it around later in the week during the Patient Advisory Council meeting at my own physician practice. (By the way, they loved it). Perhaps not surprisingly, Planetree, a national leader in patient-centered care, had wasted no time printing out a version of the Passport, so they could pilot it at their flagship hospital in Derby, Connecticut.
Having this tool filled out and ready would have saved my mom, me and the entire care team significant time and energy. But for many patients, the stakes are much higher. Maybe they’re at an out-of-town ER, where no one can get access to their medical record. Maybe they’re less comfortable with medical settings, are forgetful, have limited literacy skills, or don’t have a daughter who works full-time in patient advocacy stuck to their side. How easy and helpful it would be for them to just hand over their Passport, saying “Here you go, Doc, these are all the things I know for sure, and things I’d like you to know. And as it says right there, please call me Joe instead of Mr. Themopoulos. Now, what else do you need?”
What I also love about the Passport is that it puts some power and responsibility for care in “Joe’s” hands—creating a framework for true partnership. I hope more organizations will take advantage of this simple and free tool to engage patients, improve medication reconciliation, and even introduce the tough conversation about end-of-life care.
You can download a free Planetree Preferences Passport App at Doctella.com and create your own online version of the Passport. So far, hard copies of the Passport (perfect for my technology-averse mom) are hard to come by; after all, someone has to pay for printing.
I hope someone sees and seizes this opportunity. If you happen to own a national pharmacy chain, and want to offer free Patient Passports to your customers, this much I promise: my mom and I will be first in line.