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"Always" at the Center

By Caitlin Littlefield | Friday, October 4, 2013

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 Martha Hayward.

Edith asked: Who are the patient family advisors?

Tina Andersen: 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 patient advocate.

Cheryl asked: At Ann Arundel Medical Center, do you have voluntary medical staff? What do you see as the key to medical staff engagement?

Tina Andersen: 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 succeed. 

Katie  asked: Who would be included in the EMR that clients/patients have access to? The 5 areas identified in SMART or more in-depth information?

Tina Andersen: 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?  

Cherry Shogren: 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?

Tina Andersen: 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 data yet.  

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 re-hospitalization rates.

Lynn asked:  What about the HIPAA concern with info on white boards?

Tina Andersen: 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 referrals?

Tina Andersen: 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.

Click here to find out more and enroll!


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