Technology helps cut readmission rates
Patients access info by phone or computer
By making personalized recorded discharge information and educational videos available to patients by telephone or computer, Cullman (AL) Regional Hospital has reduced 30-day readmissions by 15% and increased scores on the discharge section of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) by 63%.
"Our hospital has been hotwired for a couple of years. If there is a piece of technology we can use to help the staff be more efficient, we are willing to be a beta site for it," says Cheryl Bailey, RN, BSN, MBA, chief nursing officer and vice president of patient care services for the 145-bed hospital located between Birmingham and Huntsville, two of Alabama's largest cities.
When the hospital was approached by a vendor to test a new solution for technology to reduce 30-day readmissions, they jumped at the chance. Using MP3 players, the nurses record the discharge instructions as they give them to patients. After they get home, patients or their family members may use a PIN to access the instructions by telephone or via computer for 30 days. The nurses still give patients a hard copy of their medication and discharge plan.
"Nursing told us that many times patients are focused on the door because they are ready to go home and they don't really listen to the discharge teaching. Another problem is that many times when the nurses go over the discharge instructions, the primary caregiver is not in the room, and when they get home and have questions about the care, the patient doesn't remember. These are real issues that happen in every hospital every day. We thought using technology would help alleviate both problems," she says.
The hospital started the initiative it calls Good-to-Go in a 31-bed step-down unit where the congestive heart failure, acute myocardial infarction, and pneumonia patients were placed and has expanded to other parts of the hospital. "We knew that if we could make a difference in readmissions on this unit, we could roll it out throughout the hospital," she says.
When Bailey explained the project to the nursing staff, they balked at first, saying they hate to hear themselves on a recording. She pointed out that the nurses wouldn't have to listen to themselves, and the nurses agreed to try it.
To increase efficiency and not add time to the discharge process, the hospital created templates that the nurses can use to make the recordings. For instance, when nurses conduct discharge teaching for heart failure, they click on the heart failure template and see all the information the patients and families need to know about heart failure, including a recording of a doctor describing the disease, instructions on how to weigh yourself, and a video from a nutritionist describing a low-sodium diet. "It's easy and simple. The nurse just adds two to three minutes of information specific to that patient," she says.
The nurses use a script that starts with them introducing themselves. They go over the medications and ask the patient to repeat the instructions. They go over the discharge plan and remind patients to take their eye glasses, dentures, or other devices with them when they leave the hospital. They end by saying, "Thank you for choosing Cullman Regional Medical Center."
"If a family member calls in, we want them to hear everything that they would have heard if they had been in the room," Bailey says.
When the initiative began, the only option was for patients to call in on a landline and listen to the instructions. Now the second version of the technology allows the hospital to include videos and written materials.
If patients or families call in on the Good-to-Go landline, they hear the live recording made by the nurse in the room and other prerecorded information. If they log into the hospital's secure access system via computer, they can access the recording, videos, and see a hard copy of the information.
The process has a lot of flexibility for customizing the information for the needs of each individual patient, Bailey says. For instance, the nurse can take a picture of the patient's swollen leg as a baseline and instruct the family to call the doctor if the leg looks more swollen the next day. The nurses can take a video on how to change the dressing on a wound. Other options the nurse can choose from include a video demonstrating how to care for a skin graft that was approved by a plastic surgeon and a video of a physician providing pacemaker education.
"We are constantly adding to our templates and videos and creating new ones," Bailey says.
The project started on the step-down unit and is being used throughout the hospital. For instance, the maternity unit uses it to help new parents learn to care for their infants. "Parents are overloaded with information. They are tired and excited and eager to get home. We went to our school of nursing and created 10 videos, including how to bathe an infant, circumcision care, the proper way to use a car seat, and breast-feeding tips. If the infant's physician has a website, we include a link to that," she says.
Other units that use the technology for patient education include surgical, medical, pre-admission testing, same-day surgery, and pediatrics. Ancillary services, such as respiratory therapy, also have created educational videos for their patients.
"Not all of the videos are aimed at reducing readmissions. We also use them to help with education and improve the patient's experience after discharge," she says.
The hospital rolled out the system in October 2011 and has modified and added to it constantly.
Bailey and the case managers and nurses can check the system to see how many times patients are accessing the videos. If the instructions have been accessed multiple times, the nurses can call the patients to see if they have questions or concerns. If high-risk patients or those who have been readmitted are not accessing the videos, the nurses know to call and check on them to make sure they understand their treatment plan.
The hospital's case management team met with all the skilled nursing facilities in the area, described the Good-to-Go project, and created a template for each one that includes directions, what financial and other information patients or family members need to bring, what personal items they should bring, what not to bring, a phone number to call if there is an issue, and other information patients need for a skilled nursing stay. When a patient and family choose a nursing home, the case manager records that conversation along with the Web address for the nursing home so the patient and family can log on and see everything they need to know. The case managers give their counterparts at the nursing home the PIN so they can log in and hear what the patients heard.
"This helps us in our efforts to improve relations with post-acute providers. The next step will be to meet with all the home health agencies and develop a template for them," Bailey says.