By: John Gauthier
Communications Coordinator (IHI)
“Always Events” have been part of the movement to put
patients at the center of their care since the beginning. On WIHI, we put our
listeners at the center of the discussion, with their great questions and
observations about the everyday work of improving health care.
The September 26 WIHI
was no exception. Almost a thousand listeners
tuned in, and they contributed a wealth of knowledge. Our guests – Cherry
Shogren of UnityPoint Health in Iowa and Tina Andersen of Anne Arundel Medical
Center in Maryland – joined Pat Rutherford and Martha Hayward, two IHI experts
working on patient and family engagement, and the next phase of Always Events Recognition at IHI.
We weren’t able to get to every question during the live
hour, so we’d like to highlight a handful of issues that came up in the WIHI CHAT that our guests addressed
after the show. The questions addressed to Tina Andersen
focused on the SMART Discharge Protocol at her hospital; the questions posed to
Cherry Shogren were about TeachBack and how its spread has become the norm at
UnityPoint. There were also some questions for the IHI team: Pat Rutherford and
Edith asked: Who
are the patient family advisors?
The patient family advisors were former patients and family members – 2 were
referred by community physicians, one by the IPFCC consultant, and one by the
Cheryl asked: At
Ann Arundel Medical Center, do you have voluntary medical staff? What do you
see as the key to medical staff engagement?
Medical staff are expected to participate in the process, especially around the
discharge itself. Lots of work has been done to make sure medical staff review
and edit discharge instructions appropriately within the electronic record.
Leadership support is key – our chief medical officer wrote the grant, so he was highly vested in seeing it
Katie asked: Who would be included in the EMR
that clients/patients have access to? The 5 areas identified in SMART or more
Basic information: vital signs, labs/tests, discharge instructions, etc. Not
the entire medical record.
Margo asked: Are
these tools being utilized in conjunction with other communications tools such
as the Interact/SBAR process to improve interprofessional exchange?
We have not formally done this but think it is a great idea. What we have done
to improve communications between staff and providers is to offer Crucial
Conversations classes to all staff. It was a requirement that our entire senior team attend and we
have had medical residents attend as well. We are also looking at starting
TeamSTEPPS in 2014 with the goal of increased collaboration and improved
communications. When we trained out teach-back coaches, they did teach-back to
us to demonstrate their understanding. I think any time we have a crucial
situation and we ask individuals if they would repeat the key points of what
was just discussed, we will end up with better results – i.e. “share what your
take aways are from our conversation,” “summarize the next steps for follow-up
to our conversation.”
Ingrid asked: Is there a discharge coordinator for each
unit? When does the discharge coordinator start to follow the patient….on
admission, or at which point during the patient’s stay? Also, is there any data
regarding the SMART format decreasing readmissions?
Yes, there is usually a discharge coordinator for all of the patients (not done
by unit), however patients going home without services don’t need much
coordination. Their primary focus is rehab/nursing home placement, home health
services, etc. Usually they are involved from admission, or close to it. No
Audrey asked: Do you think patient call-back,
post-discharge is valuable to patient outcomes?
Tina Andersen: We
actually tried post-discharge call backs for high risk patients and a random
sample of patients on our pilot units and we did not see a change with
Lynn asked: What about the HIPAA concern with info on
The patient guides what is put up there – we only write what they want us to.
Ingrid asked: We currently have a discharge nurse role in
our facility and I am looking into evolving the role…Is that something that is
done for every patient? Is there criteria for which patient populations get
Yes, there is usually a discharge coordinator for all of the patients, however
patients going home without services don’t need much coordination. Their
primary focus is rehab/nursing home placement, home health services, etc.
If you’re interested in the rest of the program,
visit our archived page over at IHI.org, check out the rest of the chat,
resources, and listen to the in-depth conversation about making “Always Events”
an important part of every patient’s experience.
Next up on WIHI: New Staffing Models for Primary Care on
Thursday, October 10 at 2:00 EST.
here to find out more and enroll!