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Getting the Message at Discharge

May 2, 2012
by John DeGaspari
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Hospital finds that better communication at discharge is linked to improved readmission rates
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In an effort to reduce its readmission rates, Cullman Regional Medical Center, a 145-bed hospital in Cullman, Ala., found that that communication issues were consistently the root cause of patients being readmitted for the same condition. This is especially a problem at discharge, when crucial information is given to the patient, who may be sent home without fully understanding his or her care plan or medications. By reinforcing discharge instructions to the patient, the hospital has been able to lower its readmission rates.

“When we drilled down on why they were readmitted, we found that they did not did not understand what they needed to do when they got home, or how to take their medications, or did not understand the instructions that the nurse or physician provided,” explains Cheryl Bailey, BSN, MBA, chief nursing officer and vice president of patient care services at Cullman. She notes there are many reasons that information may not be getting across: the patient may be frightened, hurting, or simply focused on returning home—and a family member may not be present during the discharge process.
Bailey says lack of communication is a problem with all patients, but especially so with elderly patients, who may be suffering from multiple conditions or co-morbidities, and who tend to take more medications than younger patients.
To bridge the communication gap, Cullman has implemented a solution (Patient Connect, supplied by Vocera Communications, Inc., san Jose, Calif.), which records the instructions given to the patient at discharge, and which can be played after discharge by the patient or caregiver.  The solution has been implemented initially at the hospital’s step-down unit.
When the patient is ready to be discharged from the hospital, the nurse enters the patient’s room with an “iTouch” personal communication device, Bailey explains.  The patient’s information (including name, date of birth, demographic information has already been wirelessly downloaded from the hospital’s system, is already on the device. The nurse calls up the patient’s name on the device, which displays the information.
Cheryl Bailey, BSN, MBA
At the beginning of the meeting, the nurse hands a hard copy of the medication list and care instructions to the patient and places the iTouch device between the patient and herself. She then informs the patient that she will begin recording the meeting, with the patient’s permission, and presses the record button. The device records the verbal instructions, as well as any questions the patient has during the meeting.
Also during the meeting, the nurse asks the patient for a cell phone number or the phone number of the caregiver or family member, which is also keyed into the system. Bailey notes that the system is HIPAA compliant, and access to the recording is only given to people by permission of the patient. Bailey says the hospital provides clear instructions about the process to the patient and family prior to discharge.
At the end of the meeting, the nurse stops the recording and hands the patient a sheet of paper with a toll-free phone number to call and a secure personal identification number, which the patient uses in combination with a password to access the recording. By dialing in, the patient has access to the recording at any time. The patient is encouraged to call the 800 number once before leaving the hospital to listen to the instructions again, both to reinforce e the instructions and to give the patient an opportunity to have additional immediate questions answered before leaving, Bailey says.
Also when the meeting cooncludes, the system automatically sends the recording to the patient’s phone, and then resends the message four hours later. (It does not send the message between 8:30 p.m. and 7:30 a.m.)
Bailey says the hospital’s step-down unit has recorded about 640 discharge meetings over roughly a six-month period. The numbers of patients who have accessed the discharge instructions after going home have steadily increased, she says.  In that unit, 48 percent of discharged patients who did not use the system were readmitted, compared to 41 percent who accessed the system—a 7-percent reduction.
Bailey adds that at the end of the recording, patients are asked if they are the patient, if they are glad the recording of the instructions was available to them, and if hearing the instructions again improved their understanding of them. “We’ve had 100 percent positive on all three of those questions,” she says. Bailey says the system is an excellent auditing tool, allowing her to monitor the recordings for thoroughness and clarity.
The hospital has recently expanded the system for pre-admission testing and for one-day surgery. While neither use is for preventing readmissions, Bailey believes the recording helps to make sure the patient has a better understanding of preparations for surgery and follow-up care. Bailey notes that the hospital has put in a request to purchase more iTouch devices that will be deployed in four additional nursing units.