Increasing Patient Care and Reducing Liability in Seven Simple Steps         

By Laura & Janet Greenwald


Nearly one million unconscious patients will arrive in the emergency department this year.  Although most hospitals notify patient's next of kin immediately, that call can often be delayed or forgotten.  Without it, there's no family member present to comfort the patient, make informed decisions for his care or provide the medical history that can make the difference between life and death.   

That's exactly what happened to Elaine Sullivan, a very active seventy-one-year-old woman, who slipped and fell, while getting into the bathtub.  When paramedics arrived, they realized that injuries to her mouth and head had made her unable to communicate, or as the hospital later discovered, to give informed consent for her own care.   

Although stable for the first few days, she began to slip into critical condition.  On the seventh day, Elaine died.  But that tragedy was soon overshadowed by another.  Despite having her daughter's phone number and contact information clearly indicated on the front of her chart, the hospital failed to notify her family that she'd been hospitalized until six and a half days after her admission, only hours before she died, unnecessarily and alone.    

Elaine Sullivan was my grandmother.     

In her case, placing that phone call right away, would have saved her life.  Not only would my mother Jan and I have had the time to fly back to Chicago to be at her bedside, but we would have made sure she received the care she needed.  We also would have been able to give the physicians treating her, the medical history they needed to prevent the complications and drug interactions, responsible for her death. 

After researching our own case and others like it, we realized that failing to notify a patientís next of kin wasnít an isolated problem Ė itís something thatís been experienced by countless families nationwide.  According to the CDC, nearly one million patients come into the ED every year unconscious or physically unable to give informed consent.  And with the growing number of emergency room admissions and baby boomers turning into senior citizens, the problem is only going to escalate.  Working with medical and trauma professionals, we created an easy-to-implement solution to this growing problem, by bringing together the best practices of successful trauma teams from hospitals nationwide.  The result is the Seven Steps to Successful Notification System. 

The complete system is presented in Seven Steps to Successful Notification, which is available for download, free of charge, on the NOKEP web site. Itís filled with tools your staff can use on the patient care floor to identify and locate your unconscious patientís family or surrogate decision makers, identify John Does and improve patient care and satisfaction by locating patientís medical histories quickly and easily, while complying with HIPAA standards.   

Here is a quick look at the Seven Steps.   

Step 1: Confirm Patientís Status

The moment that your staff realizes that an ED patient is unconscious or physically unable to give informed consent, and that there is no family member or surrogate decision maker in attendance, a nurse or physician is tasked with following the notification process through to completion.  The staff member indicates the patientís status on his chart along with the time, date and the stafferís initials.

Step 2:  Examine personal effects of emergency contacts 

If the patient doesn't have emergency contact information in his or her wallet, the staff member looks for it in the patientís personal effects.  The System has a comprehensive checklist of places to locate this information, from the usual to the downright creative.  

Step 3:  Locate patientís home number 

If the patient doesnít have emergency contact information, the staff member then looks for the patientís home number, going to step five if they find it and four if they do not.  

Step 4:  Seek other sources for contact information

Next, the staff member looks for the patient's emergency contact information or home phone number on records from previous admissions at the facility, or by calling his personal physicianís office, or other locations on the checklist.  If the staff member finds the information, he proceeds to step five - if not, step seven. 

Step 5:  Make the notification call 

When a contact has been identified, the staffer places a call to make the notification.   They note on the chart when the call was placed, whom they contacted, the phone number and the result.   

Step 6:  Recall main contact or second number 

If a message had to be left for the contact, or the contact doesnít come into the hospital within two hours, the staff member places one more call, to the first or a secondary contact.  If no one is reached, the staff member proceeds to step seven.

Step 7:  Shift to follow up 

When no contact name or number can be located, or if the staff member doing the notification, is unable to speak directly to the contact, they give the information to the social service department or to the local police department, as per your facilitiesí policy, for follow up.    

Following these seven steps provides your facility with documentation of the steps taken to find your patient's next of kin, make the notification, and the staff members responsible for making it.  Not only will this increase patient safety and satisfaction, it also releases your facility from subsequent liability, while providing proof that you have met your statutory responsibility. 

Talk about a win/win!

Incorporating the Seven Steps System into your trauma routine is just ONE way to increase patient safety, health and satisfaction while reducing liability.  We have many more...

The Seven Steps to Successful Notification System is filled with tools you and your ED/Trauma Staff can use to facilitate NOK notification, patient identification and communication. 

Or if you want to create change throughout your entire facility, our new Six Sigma based, HIPAA-friendly, ďCreating A Next of Kin Notification ProgramĒ has everything you need to roll out the Seven Steps System facility-wide.  The Program includes patient tracking workflows, tools and training materials, based on the Seven Steps System.  It  provides your Emergency Department staff, managers and Risk Management professionals with comprehensive training, while giving you and your hospital a fully operational Next of Kin Notification System in just 90 days. 

Check out Creating A Next of Kin Notification Program today. 




Laura and Janet Greenwald, are the founders of The Next of Kin Education Project and Stuf Productions.  The mother & daughter team were not only instrumental in enacting three Next of Kin Laws in California and Illinois, but created the Seven Steps to Successful Notification System, which teaches quick, easy, next of kin notification skills for trauma patients to hospitals like Dallasí Methodist Medical Center. 

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