Saturday, January 26, 2013

Part IV: Creating positive health outcomes for patients: Five Things Hospitals can do

 This is final post in the four part series on Creating Positive Health Outcomes for Patients:

Next week’s post will include a summary of all four posts, while this week’s focus is on what hospitals can do.

Hospital readmissions are an all too common problem, to say nothing of the complaints people make about the care they receive. "Readmission rates are a measure that shows that the system for care is not integrated well enough. It's not necessarily an indicator that the hospital is poor quality or the primary-care physician is poor quality -- it's the whole system," Audet said. "The only way we can achieve better health, better health outcomes and better cost is to bring everyone together. But it's quite a complex issue." Audet co-wrote an editorial that accompanied two new studies, which were published in the Jan. 23 issue of the Journal of the American Medical Association.  With both of these studies showing high rates of admission within 30 days after discharge, one of the findings is that patients need to understand their hospital discharge instructions. So this brings us to the first of the five things hospitals can do to create positive health outcomes:

1. Give discharge instructions to the patient and family member, advocate or friend at the same time.  All too often patients are given instructions and no one but them hears the information. By talking to the patient, with a family member, friend or advocate standing by to help with questions and writing down information, patients are more likely to have prescriptions filled, follow instructions, understand what’s normal in the healing process, who to call if they have a problem and in general address their concerns, thereby reducing the chances of confusion and the need for readmission. Because the response to this suggestion will be, “that’s a nice idea but with so many patients, who has the time to make sure this happens?” This leads to suggestion number 2.

2. Provide adequate staffing:  An appropriate workload, with sufficient nursing staff, makes for a better working environment, which in turn, according to new research,  reduces patient readmissions. If there is adequate staffing, the nurse can wait until some one comes to be with the patient at discharge, has the time to talk with them, and be sure all of their concerns are addressed.

Along with adequate staffing, hospitals need to consider when they schedule elective surgeries and admissions. Booking during holiday periods, or at the end of the week, where there is an increased chance that patients will have to be in the hospital over the weekend, isn’t the best idea as staffing is generally lower during these times.

Because the dollar is an important player in the healthcare game, it would be expected that the costs of increasing nursing staff would be offset by the reduction in the cost of readmissions.

3. Provide easy to read information for patients/family/friends. In general, patients check into a hospital and they are given a patient handbook. This document may meet a mandated need but it ‘s rarely read because people aren’t able to concentrate and/or the material provided is overwhelming in length and literacy level. If your current patient handbook has phrases like To provide facilities and amenities that promote the highest quality care, afford solace, and enhance the surrounding communities, which is a quote directly from one hospital’s handbook, you’ve lost them.

As they can benefit both hospital and patient, family/friends need guidance about what they can do. Creating Positive Health Outcomes for Patients: Five Things Family/Friends Can Do  is good basic information for them. However, because the patient is in the hospital, they also need more information pertaining to the current situation. Such items to include in a simple handout, which is completed at the time a patient is taken to a room, include:
• Patient’s room and phone number
• Special needs and concerns for this patient. What to look for, when to call for assistance
• Treatment plan-keep it very simple, including medications and special procedures
• Who to contact: information for social services, chaplain, billing, patient coordinator etc.
• Where to go for food, snacks
• The URL for the hospital’s website

A good model to use is the handout you’ll find in hotel rooms that offers basic and easy to read information to help guests get what they need to make their stay as pleasant as possible.

Keep in mind that much of the patient information materials are written well above the level of many people. To help improve medical literacy, use the Removing Barriers to better, Safer care. Health Literacy and Patient Safety. Help Patients Understand Manual for Clinician’s Second Edition

4. Develop volunteer programs that can help meet patient needs. With people retiring at greater rates than ever, many will look for volunteer opportunities, where they will be able to make a difference. There are also students, in various medical disciplines, who want experience. A well run volunteer program can make a world of difference to both hospitals and patients. Programs to consider

• Sitters: Providing companionship, sitters spend one-on-one time with a patient and help to keep them safe. While sitters are often part time jobs for nursing students and retirees, many patients need them but can’t afford them. Volunteer sitter programs are more common in pediatrics. However, with the aging population, the need will significantly increase in the coming years. The No One Dies Alone (NODA) program is one example of a type of sitter program. Basically, a volunteer companion stays with a dying patient. This program was started at Sacred Heart Medical Center, Eugene, OR and is now being implemented in hospitals all over the country. 

• Advocates: There are situations when a patient does not have family or friends that can serve as their advocate while they are in the hospital. Even if they are a well skilled personal advocate, being sick, in pain, on medications etc., can compromise one’s ability to act on their own behalf. Patients need help in understanding: how to partner with their healthcare provider, be a good decision makers, how to navigate the health system and to obtain resources in their community. Examples of programs that teach advocacy include:

-    Health Leads: Health Leads enables doctors, nurses and social workers to “prescribe” basic resources like food and heat just as they do medication. They recruit and train college students to “fill” these prescriptions by connecting patients with the basic resources they need to be healthy. 

5. Write a “prescription” for condition specific and resource information: Patients are going to use the internet to learn about their condition, so help them by identifying websites that will be the most useful to their situation. Such sites can include:
• National Association of condition specific organization (e.g. American Cancer Society)
• Local chapter of condition specific organization
• Local community resources. This can be as simple as explaining 211, now available in every state. 2-1-1 provides free and confidential information and referral. Call 2-1-1 for help with food, housing, employment, health care, counseling and more. Learn more about your local 2-1-1 by looking it up here. 

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