Type-D patients & Sign-Outs

We all know about personality types like “Type A”, but there are also patient types, especially when it comes to effective communication during shift changes and sign-outs.  We all understand the challenges of sign-out, and no one likes to get stuck with a patient who is difficult to discharge or has a hundred questions, especially when the patient was not even your patient to begin with.

My favorite thing to hear after I finish providing verbal aftercare along with a treatment plan and return precautions to a patient and asking them, “Are you comfortable with the plan I just laid out and do you have any questions?” is the patient asking me “Yes – who can take out this IV and when can I leave?”.

My least favorite things to hear might include: “Something is causing this and I’m not leaving until you figure it out!” or “I want to talk to your supervisor.”

In the interest of good communication with your colleagues and to make taking over sign-outs a little more predictable I would like to categorize the two types of patients above as TYPE-E for “Easy” and TYPE-D for “Difficult“.  It is helpful to know ahead of time when you are walking in to discharge a patient who just had a negative million dollar work up if they are a TYPE-D patient.  “Forewarned is forearmed” I think the expression goes.

• TYPE-D PATIENTS: Are DIFFICULT.  May be Difficult to Discharge.  Often want lots of unnecessary tests.  May want unnecessary medications (perhaps Dilaudid or Demerol).  Are more likely to be DRUG-SEEKERS.  Often don’t want to leave.  May want unnecessary admission.
• TYPE-E PATIENTS: Are EASY going.  Are thrilled when you find nothing dangerous.   Want to EXIT and get on with their life.  Are usually quite EASY to satisfy.

So the next time you sign out a patient ending with “… they can go home if the CT is negative and I’ve already prepared the aftercare” consider also telling your relief if that patient is “Type-D” or “Type-E” so they can be prepared before they enter the room.