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Nursing Management:
doi: 10.1097/01.NUMA.0000423780.61161.e8
Nursing/pharmacy partnership

Reducing readmissions through discharge communication

Bailey, Cheryl MBA, BSN

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Author Information

Cheryl Bailey is the chief nursing officer and vice president of Patient Care Services at Cullman Regional Medical Center in Cullman, Ala.

A new HIPAA-compliant app offers “live” instruction at the bedside.

The author has disclosed that she has no financial relationships related to this article.

One of the most important transitions in the continuum of care is patient discharge. It's absolutely essential for continued health and safety that patients understand their discharge instructions fully and are comfortable with their care plan. Unfortunately, many patients across the country will leave the hospital unsure about what medications to take, when to make a follow-up appointment, and other critical details about their care.

Although hospital caregivers explain patient-care instructions in detail and also provide a discharge packet to patients for their transition home or to another clinical setting, several studies suggest that patients often retain very little or don't understand their discharge instructions, which results in poor outcomes and unnecessary readmissions.1

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Implement the solution

Studies show that patients with a clear understanding of their posthospital care instructions are 30% less likely to be readmitted to the hospital or to visit the ED.2 It's because of industry statistics like this one, along with personal and professional experiences and thousands of patient encounters, that Cullman Regional Medical Center (CRMC) began reengineering the patient discharge process.

In October 2011, the 145-bed hospital implemented a new patient-communication solution that blends healthcare best practices with the ease and accessibility of advanced technology. Using a Health Insurance Portability and Accountability Act/Health Information Technology for Economic and Clinical Health Act-compliant application running on an iOS device, CRMC caregivers record “live” discharge instructions at the patient bedside. After the discharge communication session, the patient listens to the captured conversation and then a dialogue between the caregiver and patient occurs to clarify any confusion. This conversation is also captured by the application, tailoring the discharge instructions in the patient's own words. This fluid communication allows for spaced repetition and teach-back, which is an essential safe practice to improve healthcare outcomes.3 When our nurses tell the patient that his or her discharge instructions will be recorded, the patient realizes this information must be important. So, patients listen more closely, and our staff members speak more clearly. Capturing the live instructions is an inline part of the discharge process, so it doesn't add additional work for our caregivers, yet it adds value to the patient experience.

In addition to recording audio instructions, our caregivers use the application to attach instructional videos, images, and educational documents, so the patient, family members, and/or another caregiver can review from any computer.

Perhaps the most important aspect of the program is the ability for patients with or without Internet access to participate. Patients can access audio files using any telephone, including landline phones and smartphones, to hear all audio portions of the discharge instructions. After the transition home or to another clinical setting, the live audio and video instructions, as well as images, educational documents, follow-up appointments, medication lists, and more, can be listened to and reviewed 24/7 by the patient, family member, or subsequent caregiver via any phone or computer using login credentials.

CRMC personalizes care instructions to meet the needs of each patient. If a patient isn't tech-savvy and doesn't have a computer, we'll use the audio feature via a toll-free number that he or she calls. If the patient prefers to access the care plan via computer or has a family member living out of state who needs the information online, we can accommodate that care connection as well. Patients who access their instructions online receive a link to their personal care website, where all their discharge instructions and condition-specific education resides conveniently in one location. If there's a question, links to critical phone numbers and other information are readily available on the system.

Another advantage of the new communication technology is its auditing capabilities. Whether the patient or family chooses to receive discharge instructions by phone or computer, the hospital can monitor retrieval of the information. The auditing tool within the solution shows caregivers which patients have and haven't listened to or viewed their instructions and how many times the instructions are accessed. Monitoring patient usage provides valuable insight into cases and allows us to gauge compliance and identify potential risks.

In addition to tracking patient retrieval of care instructions, the monitoring tool allows CRMC management to audit each discharge communication session, providing transparency and accountability, as well as an opportunity to recognize staff for a job well done or provide teaching opportunities to ensure quality, patient engagement, safety, and compliance of discharge process protocol.

After the solution's initial success, it quickly evolved from being a discharge communication technology to a vital patient education tool. CRMC now uses it to prepare patients in preadmission testing and outpatient surgery. The hospital also created a newborn care library with the application. When new mothers and fathers leave the hospital, they can access their personal website via smartphone, tablet, or computer to view educational documents and videos, which provide coaching and care instructions to assist them with the care of their baby. Next steps include rolling out the solution to all physicians, who will have the opportunity to personalize the application with videos, educational documents or forms, and links to their practice websites.

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Measure results

Over a 6-month period, the hospital experienced a 7% point reduction in readmissions when the solution was used. We also saw notable increases in Hospital Consumer Assessment of Healthcare Providers and Systems scores for two questions related to discharge communication. There was a 58.8% increase in patients who said they received information about symptoms or health problems to look for when they left the hospital, and a 56.9% improvement in hospital staff talking to patients about help needed after discharge.

Patient satisfaction was also measured with a CRMC survey specifically designed for the solution. Results showed that 100% of users surveyed from the inpatient setting said “hearing the recording improved their understanding of their discharge instructions,” and 100% said “they were glad a recording of their discharge instructions was made available.” Of these respondents, 50% represented the actual patient, and the other half made up family members.

In the outpatient setting, 100% of users surveyed said “hearing the recording improved their understanding.” Seventy-five percent of these users were the patient and 25% were a family member or friend of the patient.

CRMC has also seen an increase in staff satisfaction, with 96% of CRMC caregivers surveyed indicating the solution and its various applications are valuable to the patient. CRMC caregivers feel better knowing discharged patients are only a click or call away from the information they need to continue their care.

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References

1. Holt JE, Flint EP, Bowers MT. Got the picture? Using mobile phone technology to reinforce discharge instructions. Am J Nurs. 2011;111(8):47–51.

2. Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009;150(3):178–187.

3. National Quality Forum. Improving Patient Safety Through Informed Consent for Patients with Limited Health Literacy. Washington, DC: NQF; 2005.

© 2012 by Lippincott Williams & Wilkins, Inc.

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