Although hardly restricted to the requirements of The Joint Commission or other agencies, complex and wordy signs add to the visual chaos and actually impair compliance. “Too many signs try to communicate too much information out of a fear that they may be leaving something important out,” Dr. Bogner says. “It is a lot easier to put everything in than to distill things down to get to the nugget you want to get across.”
David Yu, MD, FACP, medical director of hospitalist services at Decatur Memorial Hospital in Decatur, Ill., agrees. A member of Team Hospitalist, Dr. Yu’s mantra is “less is better.” Put the fewest words possible on the sign, then educate the staff on how to implement the information.
“We discourage signs that are overly verbose,” he says. “At the end of the day, the efficacy of signs depends largely on the training and attentiveness of those caring for the patient. It is not fail-safe and requires the staff to acknowledge the sign and institute the indicated policies correctly.”
In some cases, the best sign might not even be a sign.
“Color coding is used extensively in the military,” Dr. Yu says. “On an aircraft carrier, all of the people running around the deck are color-coded. Just by looking around, you can see who deals with armament, who is the refueler, and who does traffic control.”
Dr. Yu’s hospital issues red footies to patients who are at high risk for falls. When any staff member sees a red-footed patient wandering around without an escort, they immediately know they should intervene. It conveys the required message anywhere in the hospital.
I would like to see a system where only truly high-risk patients are the ones who get the warnings.
—David Grace, MD, FHM, area medical officer, Schumacher Group, Lafayette, La.
“Fire and Forget”
Although many visual warnings have the best of intentions, it doesn’t mean they are effective. Few hospitals have systems in place to follow up and make sure the warning actually has an effect on patient care.
“Alerts should be viewed initially as an experiment, requiring tracking to make sure it works as intended,” says Scott A. Flanders, MD, FHM, president of SHM and professor of medicine and director of the hospitalist program at the University of Michigan at Ann Arbor. “Too frequently in healthcare we put up signs in an attempt to fix a problem, but then don’t follow up to see if it is working.”
A similar phenomenon is seen when early warnings follow a patient through subsequent hospitalizations. This is especially true with isolation protocols, as the patient might not require the same warnings as previous admissions.
“It seems as though anyone who has ever had methicillin-resistant Staphylococcus aureus [MRSA] gets one of those things slapped on their door the minute they come in,” Dr. Grace says. “I have personally seen patients who had a boil grow out [of] MRSA 10 years ago still get a sticker on their door after all this time.”
Thus, warning signs that are not serving their intended purpose don’t ever get taken down; they dilute the usefulness of those that are timely and effective. The trend might indicate that defensive signage (a cousin to defensive medicine) is a driver, the theory being it’s safer and “legally defensible” if a hospital posts a multitude of alerts, rather than miss a sign that could have averted a poor outcome.