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Patient Experience Case Study - CRMC
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Recording Discharge Instructions to Improve Patient Compliance and Satisfaction

What was the challenge, opportunity or issue faced?

Cullman Regional Medical Center (CRMC) in Cullman, Alabama faced one of the most important transitions in the continuum of care, the transfer of caregiver responsibility from hospital staff to the patient or a family member at discharge.

"It is vital for safety and satisfaction that patients feel comfortable with their post-hospital plan of care and that they understand all their discharge instructions,” said Cheryl Bailey, BSN, MBA, CNO and Vice President of Patient Care Services at Cullman Regional Medical Center.

Studies show that patients who simply understand their post-hospital care instructions are 30% less likely to be readmitted or to visit the emergency department. (B.W. Jack et al. Annals of Internal Medicine 150, 178-187, 2009).

However, discharge can be a stressful time for patients and their family, and they may not hear or understand all the complex clinical information communicated to them when they are ready to leave. Relying on traditional packets with multiple pieces of paper is not adequate. There is no guarantee this information makes it out the door with the patient and no way to track if the patient read or understood the instructions.

What did you do to address it?

CRMC is improving patient understanding, compliance and experience by engaging and empowering patients and their families at discharge.

"We are combining healthcare best practices with advanced technology to make a positive impact on patient experience and outcomes,” Bailey said.

The Hawthorne Effect tells us that people who know they are being observed perform better. Using this principal and other best practices, CRMC implemented Good to Go – Patient Care Connection by Vocera Care Transition. Good to Go records "live” discharge instructions between the caregiver and patient using a HIPAA/HITECH compliant application running on an iOS device and then shares the captured conversation with patients after discharge.

"When our nurses tell the patient their discharge instructions will be recorded, the patient realizes this information must be important. So, he or she listens more closely, and our staff speaks clearer,” Bailey said.

Following the discharge communication session, the nurse asks the patient to review their captured conversation and clarify any confusion. This dialogue in the patient’s own words allows for spaced repetition and teach-back, which is "an essential ‘safe practice’ to improve outcomes,” according to the National Quality Forum.

In addition to recording audio instructions, CRMC caregivers use Good to Go to capture or link instructional care videos, pictures and other hospital resources to enhance patient education and understanding. After hospital discharge, the patient, a family member or another caregiver can securely access the multimedia information 24/7 using a landline, smartphone, laptop, tablet or computer.

To ensure quality communication and identify staff teaching or recognition opportunities, Good to Go provides auditing capabilities that allow CRMC management to review every discharge session. The solution also monitors which patients have listened to or accessed their instructions, providing insight into potential compliance issues.

"If a patient has accessed their instructions multiple times, it may indicate that additional education is needed, and one of our staff members can use this information to contact the patient and address any questions.” Bailey said.

Good to Go also allows caregivers to set automatic text reminders, task lists and audio messages for patients to encourage compliance.

What were the outcomes?

Since implementing Good to Go, CRMC has seen a tremendous increase in HCAHPS scores.

- 56.9% score increase for this question: "During the hospital stay did you get information about what symptoms or health problems to look for after you left the hospital?”

- 58.8% score increase for the question: "During the hospital stay, did doctors, nurses, or other hospital staff talk with you about whether you would have the help you needed when you left the hospital?”

In addition, post intervention results within a 6-month period indicated a 7 percentage point reduction in readmissions when patients accessed their audio discharge instructions via Good to Go compared to patients who did not.

Hospital satisfaction surveys about Good to Go have also resulted in positive outcomes. Among the patients surveyed, 100 percent said, "Hearing the recording improved their understanding of the discharge instructions.” 100% of inpatients surveyed also said they were glad a recording of the discharge instructions was made available. The CRMC nursing staff is also very satisfied with the new solution with 96% of the caregivers surveyed saying Good to Go is valuable to the patient.

Success of the solution started in a step-down unit, which inspired CRMC to expand Good to Go to other patient care directives including instructions for pre-admission testing, one-day surgery, maternity and new-born education, respiratory therapy, ED discharge and physical therapy.

"The Good to Go solution is a valuable patient communication and education tool. We were told by a Joint Commission surveyor that it is a best practice,” Bailey said.

About Cullman Regional Medical Center
Cullman Regional Medical Center is a 145-bed medical center that is owned and operated by the Health Care Authority of Cullman County that serves more than 150,000 residents in a six-county area and is recognized as one of the region’s finest medical facilities. The hospital is part of an extensive medical complex built in 1995 that contains some of the newest medical equipment and technology available today.

Mission:
We are dedicated to promoting wellness by providing excellent healthcare services in the most efficient manner and exceeding the expectations of those we serve.

Vision:
We aspire to be the leading community based healthcare provider in the Southeast.

Values
We believe in:

  • Doing the right thing for the right reason
  • Valuing each patient, visitor, employee, physician and individual we touch
  • Being a wise steward of community resources
  • Respecting the sanctity of human life
  • Providing service with compassion

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