Where: Cullman Regional Medical Center, a 145-bed hospital in Cullman, Ala.
The issue: Reducing readmissions by improving discharge communication.
Clinicians at Cullman Regional Medical Center (CRMC) are early adopters. “At our hospital, we love technology. We embrace change,” said Cheryl Bailey, RN, BSN, MBA, chief nursing officer and vice president of patient care services.
The hospital's leaders are also eager to reduce their rate of 30-day readmissions, of course. So when a health care technology company asked them to try out a new system that would require little change in workflow but could potentially reduce 30-day readmissions, they were happy to oblige.
How it works
The system, called Good to Go, provides discharged patients with recordings of their predischarge conversations with nurses.
“The nurses still perform the same discharge process that they always have. They'll review the orders. They'll gather their paperwork on medications. They go in the room and provide all the teaching,” explained Ms. Bailey. “The difference is now they carry in an iPod Touch and they tell the patient, ‘I'm going to record your discharge teaching so that when you get home, you or your family member can phone in and listen to this conversation, or you can log on to the Internet.’”
After the nurse has finished the recording, the vendor uploads it to a cloud storage system and the patient is given an individual access code. Those who access their recordings through the Web rather than by phone (which is about 40% of those who use the system) may also be directed to patient education about their diagnoses.
“It meets all the HIPAA/HITECH regulations, so then if the patient wants to have their family member or a neighbor phone in and listen to the information or log on, the patient is the one that will provide them with those numbers,” said Ms. Bailey. The recording is available to the patient for 30 days after discharge.
The system is compatible with any Apple device, but the hospital chose iPod Touches for their small size and ease of use. “Plus they're inexpensive. We bought two or three for the unit. I keep those with the charge nurse,” said Ms. Bailey.
In October 2011, Good to Go was launched on CRMC's 31-bed step-down unit. “That's where our congestive heart failure, our pneumonia, our acute myocardial infarction patients are placed. [I thought] if it can make a difference in decreasing readmissions on that unit, with that population, then this should be a home run in any other department,” Ms. Bailey said.
She and the directors of the unit randomly listened to the recordings and soon observed a difference. “They're doing a much better job teaching,” she said. “We're getting confirmation of that, because we'll often hear on the recording the patient or family member telling the nurse, ‘Wow, you did a great job with that.’”
In addition to the anecdotal improvements, the new system was associated with significant change in 30-day readmissions and patient satisfaction scores. “We have reduced readmissions by 15% and we are maintaining that,” said Ms. Bailey. “Our HCAHPS scores improved. There are two questions that focus on the discharge process and we saw a 62% and 63% increase in those scores.”
She attributes the results to the option to listen to the recordings (which about 50% of patients do), and a change in attitude during discharge education. “The patients think, ‘Wow, they're recording, so that means it must be important, so I better listen.’”
How others benefit
Now that the program has been rolled out across CRMC, patients aren't the only ones listening to the recordings. When a patient is being discharged to a nursing home, a hospital case manager will record the conversation with the patient. “Then our nursing home partners can phone in and listen to the conversation a case manager had with a patient and family,” said Ms. Bailey.
Challenges and next steps
Nurses were concerned the program would add time to the discharge process. But, in practice, the hospital has found the recordings add less than two minutes, Mrs. Bailey said.
At the moment, patients with certain diagnoses who log in to the website to review their recordings can also view educational videos, recorded by Ms. Bailey on one of the hospital's iPods. “Patients can see a video of their doctor talking to them about what he did,’” said Ms. Bailey. In the future, she hopes to offer videos for more diagnoses and procedures. “Every physician I've talked to has loved the idea,” she said. “The challenge has been getting on their schedule to record the video,” said Ms. Bailey.