Patient Prioritization and Interviewing Techniques

Level One Priority

• Definition: Life-threatening situations; immediate intervention required.
  • Examples:
  • Airway Blockage: Patient cannot maintain an airway.
  • Severe Bleeding: Patient is bleeding out, risk of death if not treated immediately.
  • Respiratory Distress: Patient cannot breathe, urgent need for intervention.

Level Two Priority

• Definition: Less critical than level one but still requires prompt attention.
  • Examples:
  • Altered Level of Consciousness:
    • Changes in responsiveness can indicate oxygen deprivation to the brain, warranting immediate assessment.
    • Previous status of being alert now presenting as drowsy or confused.
  • Acute Pain:
    • Sudden onset of pain that differs from typical pain progression (not post-op pain).
    • Example: Post C-section patient experiencing sudden escalated pain and internal bleeding detected via CT.

Level Three Priority

• Definition: Problems that need to be addressed but are not life-threatening.
  • Examples:
  • Chronic Pain: Ongoing pain that is stable over time and manageable.
  • Knowledge Deficits: Patients requiring education (e.g., managing diabetes).
  • Nutritional Issues: Needs for dietary counseling that do not pose immediate risk.
  • Mobility Concerns: Needs for assistance with movement that could lead to longer term complications but are not urgent.

Patient Assessment Prioritization

• When assessing multiple patients, consider the immediate threats to life first.
• Patient example assessment:
  • Patient with an acute asthma attack needs prioritized attention over a patient with a history of seizures who is stable.
  • Confused patients are lower priority compared to those experiencing respiratory distress.

Conducting Patient Interviews

• Objectives:
  • Ensure privacy and minimal distractions during the interview process.
  • Maintain a comfortable distance (4-5 feet recommended) to facilitate conversation.
  • Avoid harsh or direct lighting that could make the patient uncomfortable.
  • Aim for equality in seating arrangements to help patients feel less intimidated.

Key Interview Phases

• Introduction Phase: Set a positive and comfortable tone for the interaction.
• During the Interview:
  • Use appropriate language, avoiding medical jargon to ensure understanding.
  • Ask open-ended questions to facilitate dialogue.
• Closing Phase: Summarize the key points discussed to affirm understanding and provide a moment for the patient to offer additional information or concerns.

Common Interviewing Traps

• Providing False Reassurance: Avoid saying "Everything will be okay" without basis. Be honest while providing support.
• Unwanted Advices: Do not assume patient preferences; instead, encourage them to express their concerns.
• Using Authority: Avoid statements that imply patients must comply with treatment without discussing reasons.
• Language Sensitivity: Use direct and clear communication avoiding vague terms like “passed on” when discussing death.
• Interrupting or Talking Too Much: Be conscious of allowing patients the space to speak without overwhelming them.
• Leading Questions: Steer clear of questions that suggest a judgement or expectation, such as "You don’t smoke, do you?"

Special Considerations

• Elderly Patients:
  • May take longer to respond due to cognitive or sensory deficits.
  • Value their experience – may share long, detailed stories that can sidetrack the interview.
  • Ensure comfort and understanding in communication, especially regarding sensitive topics affecting their autonomy.
• Acute Illness Considerations: Focus on pertinent information relevant to their immediate medical needs without conducting extensive exploration if they are in critical condition.

Patient Safety and Documentation

• Document observations carefully, especially in sensitive situations such as suspected abuse.
• Ensure that your documentation reflects the patient's own words to maintain accuracy for potential legal implications.

Mental Health Evaluation

• Assess mental status through orientation questions, perceptions, and thought processes.
• Look for signs of cognitive decline or mental instability, such as disheveled appearance or incoherently disorganized thoughts.
• Take note of behaviors and mentioned obsessions or repetitive thoughts as indicators of potential psychological concerns.