Help for patients leaving the hospital can keep them from coming back
Going home from the hospital can be confusing for patients. It can also be dangerous if they don't grasp their diagnosis, their medications, or what kind of follow-up appointments they need to keep.
For one in five patients, problems with medications or other complications mean a return trip to the hospital, according to the Agency for Healthcare Research and Quality.
A team at Boston Medical Center devised a program in which nurses used a personalized booklet to teach patients about their conditions, explain the medications they need to take, and arrange appointments with the doctors they need to see. A pharmacist called the patients about two days later to check on their medications.
In a randomized clinical trial of the program, half of about 700 patients got the intensive discharge education plus followup while half got the standard discharge instructions. Patients who got the extra attention were 30 percent less likely to return to the hospital, whether it was a visit to the emergency room or readmission as an inpatient. The results of the study appear in tomorrow's Annals of Internal Medicine.
"The intervention showed a remarkable effect, much more than any of us ever imagined," Dr. Brian Jack, who led the Boston Medical Center team, said in an interview. "If you apply that to 38 million discharges [a year across the country], that's a real lot."
Overall, the program saved $412 per patient, after accounting for the extra time spent by the nurse and pharmacist to go over the patient's plan and medications.
"There are not too many things that improve health and save money," Jack said.
Patricia Rutherford, vice president of the Cambridge-based Institute for Healthcare Improvement, called the study's results "very good news."
"They have hit upon some very important actions that if they were uniformly adopted could significantly help with this problem," she said.
Using a plan that the patient understands, putting it in writing, and bridging gaps between the hospital doctors and the patient's doctor in the community are key factors for success in the handoff between hospital and home, she said.
"First and foremost, it's better care, and second, it's at reduced cost," she said.
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I worked in home care for 20 years and was always appauled when I visited patients and found that they knew so little about their medications and that there was no designee at the hospital for them to call with questions. When accessing the primary physician's office to verify the patient's medications, the primary physician did not know what meds the patient was taking; the same person who would be signing orders for home care! Currently, with hospitals employing hospitalists, the problem has intensified.
I would like to adapt this process to the Rehab and Skilled Nursing setting in nursing homes. Please let me know who to contact.
Peggy,
Here's a response from Dr. Brian Jack, who led the study:
For those interested in adapting the ReEngineered Discharge project to their settings, you can visit the Project RED website at: http://www.bu.edu/fammed/projectred/
On the website is a tab “click for Project RED tool kit” - from here you can download an example of the “After Hospital Care Plan (AHCP)” and our discharge advocate training manual. As our website describes, we are now working on a health IT system that is a computerized animated character who teaches the AHCP and documents the interaction. If individuals or organizations have questions they can email me directly.
Brian Jack MD
Boston University School of Medicine / Boston Medical Center
Brian.Jack@bmc.org
Hey Nancy,
I get these American Nurses Association daily stories and it is kind of neat sometimes...thoughts maybe you would be interested in reading this, since it is regarding patient education. Hope you have a great day!
This is an important topic and should get the utmost attention. Patient Safety is everyone's problem and is paramount in healthcare. I think it's very important to close the gaps between caregivers and omit the possibilities of mis-interpretation especially after leaving the hospital. National Patient Safety Goal #8 for 2009 also addresses the issue of improving patient safety through standardization of goals that focuses on problems that presently exist in health care-Reconcile Medications on admission or entry to the organization....In conclusion medication error is a big issue and by reconciling medication and educating patients and their family members before going home can help to eliminate harm that the patient may experience and ultimately re-admiision to the hospital.
This blogger might want to review your comment before posting it.
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