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
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