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Survey discharged patients to find out
Too often, case managers discharge patients from acute care without ever finding out whether the education those patients received in the hospital really prepared them for the next stage of their treatment. Aware of that problem, case managers and administrators at Fairview University Medical Center in Minneapolis decided to construct a survey that would help them find out just how effective their discharge planning efforts had been.
Now, with the help of the patient relations department, a multidisciplinary team distributes a specially prepared patient satisfaction survey to 200 patients each week, asking the following three questions:
• When you left the hospital, did you have a better understanding of your illness than when you entered?
• Before you were discharged, did the hospital staff prepare you or your caretaker to manage your care at home?
• Were you sent home from the hospital before you felt ready?
The Patient Learning Center at the hospital, which provides individual instruction for patients and family members, also randomly calls 10 to 15 patients a month to ask how they are managing their care after discharge. "We are specifically interested in knowing whether they received all the information they needed to safely care for themselves on their own," says Nancy Goldstein, MPH, patient education program manager at Fairview-University Medical Center.
The nurses who make the calls also ask about the consistency of the information the patient received while in the hospital and whether the information was easy to understand. The hospital tried mailing the surveys and also giving the patients a questionnaire before leaving the hospital, but those methods were not satisfactory.
"Patients did not return the mail surveys, and we did not get the information we wanted from patients that hadn’t been at home for a while managing on their own," explains Goldstein.
The best way to evaluate the effectiveness of discharge planning is through conversation, says Fran London, MS, RN, health education specialist at The Emily Center at Phoenix Children’s Hospital. "You find out if a patient is ready for self-care upon discharge by asking," she explains.
However, questions should be specific rather than general. Have the patient demonstrate understanding, she advises. For example, rather than asking patients if they understand what they were taught and if they are ready to go home, ask them to explain the signs and symptoms of infection and how they would respond should one occur.
"Offer a scenario of something that could go wrong after discharge, such as missing a dose of medication, and ask the patient what he or she would do in that situation," suggests London.
To determine if patients will implement the plan of care, such as a change in diet, ask how they will go about making the changes. Also ask what will make it difficult to implement the plan and how the patient will deal with that difficulty. "If the plan was imposed rather than mutually agreed upon, the patient may not know how to modify it to fit into his or her lifestyle," London explains.
When patients must learn skills for appropriate self-care at home, the best way to evaluate their learning is to watch them demonstrate the skills. It’s best if patients practice the skill several times during hospitalization. This not only provides practice; it gives the nurse or case manager an opportunity to evaluate the patient’s understanding of the process and ability to problem-solve should something go wrong, says London.
Evaluating a patient’s learning before he or she is discharged is a good way to determine if the education was appropriate, agrees BJ Hansen, BSN, patient education coordinator at Grant/ Riverside Methodist Hospitals in Columbus, OH. Nurses at the hospitals are instructed to ask specific questions, such as: "What would you do if your incision was red?"
The depth of the follow-up and evaluation, however, should depend on the diagnosis, says Hansen. A person who has general surgery will usually not need to learn that much for a safe discharge, while a cardiac patient could require a lot more education. For example, patients who have had open-heart surgery receive a follow-up call seven days after discharge and are asked questions about their condition. These questions include:
• Have you had any ankle or foot swelling?
• Do you have any questions about activity instructions?
• Are you following your walking schedule?
• How many minutes are you walking?
• Do you have any questions about your medication?
Patients diagnosed with a chronic disease that requires lifestyle changes are referred to outpatient programs for detailed education. "In the acute setting, people are so sick and are hospitalized for such a short period of time that they are overwhelmed with a lot of different information. For lifestyle changes, we would like them to come in as an outpatient," says Hansen.
For example, it is much better for a patient to come back a week later for a consult with the dietitian and spend one or two hours going over the information than to receive extensive diet instructions before discharge.
Many of the outpatient courses patients are referred to provide detailed teaching, and the teaching is evaluated to determine if it is effective. "We do more extensive follow-up on our more extensive programs," says Hansen.
For more information on evaluating the effectiveness of your discharge planning, contact:
• Nancy Goldstein, MPH, patient education program manager, Fairview-University Medical Center, University Campus, Box 603, Harvard St. at East River Parkway, Minneapolis, MN 55455. Telephone: (612) 626-6356. Fax: (612) 624-0651.
• BJ Hansen, BSN, patient education coordinator, Grant/Riverside Methodist Hospitals, 111 South Grant Ave., Columbus, OH 43215. Telephone: (614) 566-5613. Fax: (614) 566-8067. E-mail: firstname.lastname@example.org.
• Fran London, MS, RN, health education specialist, The Emily Center, Patient/Family Education Program, Phoenix Children’s Hospital, 909 East Brill St., Phoenix, AZ 85006. Telephone: (602) 239-2820. Fax: (602) 239-4670.