Project Timeframe: October, 2012 – ongoing
The first few days at home following a hospitalization can be confusing for many patients. There may be new medications to take, or a new schedule for taking old ones. There are follow-up appointments to keep, and maybe a new diet to get used to. Information that made sense when the Nurse explained it in the hospital may not be so clear a few days later. Having someone to check in with can help.
Studies have shown that a post discharge call to a patient increases that patient’s ability to follow the discharge plan, increases their understanding of their medication regime, and decreases anxiety. A phone call helps reinforce information about follow up appointments and any diet or exercise recommended by the physician and can help solve any problems in transitioning from hospital to home. A phone call allows the patient to provide immediate feedback about their hospital stay — what went well and what could have been better — and increases their overall satisfaction with their hospital experience.
Survey data for BMH patients indicated that there were a variety of opportunities to improve our patient s discharge through follow up calls. Through these surveys patients were telling us that they needed more information and guidance in the discharge process. They were also identifying multiple areas for improvement during their hospital stay.
To develop a post-discharge call process by which BMH nurses could reinforce education provided to the patient while in the hospital, help sort out medication routines, remind the patient of the important of keeping scheduled follow-up appointments, respond to any questions the patient may have, and elicit feedback about the patient’s overall hospital experience.
With the engagement of Primary Care Providers, Care Managers, Nursing and Administration, a pilot program was developed and initiated during the late summer and fall of 2012. This short term pilot helped us identify appropriate questions, develop optimal process flow for completing the calls, refine our data collection ability, and assess staffing needs to accomplish our goal. In early 2013 BMH hired a Patient Experience Coordinator, to further develop the call program, train Nursing staff in appropriate call back technique and data collection, and serve as primary contact for patients with active care or post-discharge questions or concerns.
In February we began to contact all patients discharged from our medical-surgical services, within 24 to 72 hours post discharge. The content of the call includes pain management, medications, follow up appointments, disease/health management, discharge instructions, home care services, and reinforcing safety initiatives. The call also provides patients with an opportunity to identify any concerns they had related to their hospitalization.
Calls are completed by the Patient Experience Coordinator or by other trained nursing staff. Callers follow a call script and enter data into a matching flow sheet to ensure consistency in reviewing essential discharge information. Prior to each call the nurse reviews the patient’s discharge summary, discharge education and instructions, medications and nursing progress notes.
From March to July, 2013, over 365 calls were completed: Based on these calls the following data was abstracted:
Top five information categories that needed to be supplemented at the time of patient contact.
- Discharge Information 23%
- Follow Up Appointments 17%
- Medications 9%
- Pain Management 7%
- Safety 5%
For each of these categories we were able to provide the appropriate information and/or coaching to the patient. Thus, we were able to close an information gap for the patient and improve adherence to the overall discharge plan.
Concerns identified by patients during their hospitalization:
- Pain 21%
- Nurse 19%
- Emergency Department 12%
- Other 16%
Every patient concern is investigated with an effort to provide coaching to staff where applicable. For concerns that have a more generalized theme we implement more global efforts to educate staff and provide a systematic approach to decrease occurrences.
We have recently incorporated patients discharged from the Ambulatory Care Unit and the Birthing Center into our call back program. Our next step to initiate call backs to targeted patients discharged from the Emergency Department. We will also continue to address patient concerns with prompt follow up and staff coaching when warranted, to develop strategies to enhance the experience of our patients and to audit various components of the patient experience to verify adherence to our quality and service improvement efforts.
Michele Rowland, RN, LICSW
Executive Director, Quality, Utilization and Care Management
Brattleboro Memorial Hospital
17 Belmont Avenue, Brattleboro, VT 05301