Moving appointment times

[smartcookie]

I have a lot of patients who miss or shorten treatments.  I have tried sending letters home, talking to the patient weekly, explaining the health concerns to them, rearranging schedules, talking about different types of dialysis if HD is the problem, etc.  Now I am at a point with a couple patients where I am going to have to switch their chair times to TTS second shift.  No one likes that.  I hate doing it, but I have a list of patients who come and complete treatments waiting for better chair times. 

What do you all think of this policy?  Should someone lose their MWF chair time due to noncompliance?  What about the patients who come and do what they are supposed to?  Should they get preference for better chair times? 

[iolaire]

What do you all think of this policy?  Should someone lose their MWF chair time due to noncompliance?  What about the patients who come and do what they are supposed to?  Should they get preference for better chair times?

Yes, there is no need to hold good spots for people who choose to not use them.

[Michael Murphy]

Personally after 4 years of dialysis I have never been late or missed a session.  I aim to arrive at least 30 minutes before my chair time to insure I am on time.  Since I am put on at 5:30 am if I was late it impacts the next 3 shifts.  If you are constantly late every one who follows you in the chair will have to wait and they too need to be able to make appointments after their session. If you are so self centered that you will come in at what ever time you want to then in my humble opinion is that the last shift is where you belong and if you are constantly late the time you miss should be added on to your next treatment.

[kristina]

Hello smartcookie, I agree with iolaire and Michael and it is rather unfair, to let people, who take their dialysis-sessions seriously, wait, because some others could not really bother and have no consideration for others who also need their dialysis-treatment. I say this because I often have to wait over 90 minutes, if not longer, for my "spot", because others could not care less and they are hardly ever in time.
Despite these experiences, I am always half an half early, just in case ... and as you can very clearly see, I am still living in hope...
Good luck wishes from Kristina 

[smartcookie]

Thank you for your replies!  I feel the same way, but I am tenderhearted and hate moving somebody due to non-compliance.  ::sigh::

[Simon Dog]

A reasonable solution would be to give the patient advance warning - "if you continue to leave early or miss treatments, you will lost your MWF chair time".  Bonus points if you deliver it in writing and demand they sign an acknowledgement of receiving the warning.   This way, you avoid ex post facto consequences, and the patient can make his/her own choice.

[PrimeTimer]

I have a lot of patients who miss or shorten treatments.  I have tried sending letters home, talking to the patient weekly, explaining the health concerns to them, rearranging schedules, talking about different types of dialysis if HD is the problem, etc.  Now I am at a point with a couple patients where I am going to have to switch their chair times to TTS second shift.  No one likes that.  I hate doing it, but I have a list of patients who come and complete treatments waiting for better chair times. 

What do you all think of this policy?  Should someone lose their MWF chair time due to noncompliance?  What about the patients who come and do what they are supposed to?  Should they get preference for better chair times?

I'd say that if they've been warned about other people who are compliant and needing their chair time, then it's fair game. They've been warned. We'd be angry if hubby needed or wanted a specific chair time but was turned down because it was being taken by someone who doesn't take their treatment as seriously. It's not a beauty parlor or barber shop. It's a medical treatment and some of us are very very good about adhering to a treatment plan.

[iolaire]

A reasonable solution would be to give the patient advance warning - "if you continue to leave early or miss treatments, you will lost your MWF chair time".  Bonus points if you deliver it in writing and demand they sign an acknowledgement of receiving the warning.   This way, you avoid ex post facto consequences, and the patient can make his/her own choice.

I agree with this.  It could be rolled out to the entire center.  Some sort of commitment to treatment time agreement which states something along the lines of if you repeatedly show up late or miss your shifts you will be moved to a time that can better accommodate you.  However it should also note something along the lines of if you are more than X minutes/hours late you will need to come back on the next available shift (so the last shift's workers are not stuck staying very late post shift for those people).

[cattlekid]

I probably sound heartless, but I was a TThS late shifter so that I had minor impact to my work schedule.  I would leave work at 2:30 so that I could get to the center by 3:30 for my shift at 4:00.  It was iron clad, there was no scheduling meetings with me that lasted past and preferably before 2:00.  If my 4:00 chair time was constantly missed because of late people on the previous shifts, I would have raised a major stink with the facility administrator.  I agree with others that people who are late should not be allowed to consistently impact the schedules of those that come after them.

[GA_DAWG]

I think your plan is completely the right thing to do. Nothing is more frustrating than arriving for your time and having to wait a half hour because the person ahead of you in the chair decided to sleep in, or having finished your time, having someone decide they want to get off early start screaming to take them off. Those who do not take the treatment seriously deserve no pity. At our center those are usually the ones who complain about the staff when they wind up hospitalized for fluid build up.or who tell the doctors they just do not know why the staff takes them off early.

[smartcookie]

   I feel so much better getting some validation on this!!  Thank you all for your comments!!

[Simon Dog]

Those who do not take the treatment seriously deserve no pity.

Just remember where Sympathy is located in the dictionary