Nurses on every unit with the exception of Psychiatry and ICUs began calling discharged patients at home within 72 hours of discharge in an effort to improve patient satisfaction. All units will be launched by the end of April, and they were given a few possible models to use to support nurses on each unit to make the phone calls. Each call takes about five minutes, and on average, nurses make about five calls per day.
Early results have shown a dramatic improvement in patient satisfaction, and a surprising morale boost for nurses who make the calls. The unit B1, which began conducting discharge phone calls in December 2012, experienced dramatic improvement in its "Likelihood to recommend score," moving from the 3rd percentile in December 2012 to the 98th percentile in February 2013. These are early signs that the discharge phone calls are having an effect on patient satisfaction and we are tracking the data until mature to see the final results.
For Wendy Foad, RN, associate chief nursing officer, the program launch was the "right thing to do. We could see that this was a best practice at other organizations, and we wanted to add it to our patient experience," she says. To test the program, Foad asked two of the hospital's busiest units, D2 and G2S, to pilot the idea. Melissa Aurelio, RN, and Hirut Truneh, RN, used the experiences from other hospitals as a framework for building the model used by SHC.
In the beginning, their team had difficulty making the calls within the 72 hour time period. It took time to ingrain the idea in the staff, and adjust to the workload. At one point, Truneh began making calls herself to help keep the effort on track. What she found surprised her. "There was one call I will never forget," says Truneh, patient care manager of the Intermediate ICU. She spoke to a patient from the East Bay who told her, "I never knew nursing could be this good." That experience illustrated the benefits of the discharge phone call program for both patients and nurses, and it helped her sell the concept to her staff.
"It's rewarding to hear about your unit, your colleague's work and how it's reflected in the patient's experience first hand," says Truneh. Echoing that sentiment is Assistant Patient Care Manager Melissa Aurelio, RN. "Once nurses started making the calls, they enjoyed hearing from patients,” she says. "And with just three to five calls to make each day, it's a manageable task."
An extension of patient care
The discharge phone calls are made from a nursing perspective, and are intended to maximize the patient experience, ot to provide medical advice. Nurses spend about five minutes with patients on the phone and ask the following questions -- Did you understand all of the discharge instructions provided to you? Have you been able to fill your prescriptions? Do you have any questions about your medications? Are you having any pain related to your condition? Have you been able to make follow-up appointments with your doctors? May I ask how your care was? Is there anything we could have done differently? Follow-up from every call is documented in Epic using a telephone encounter.
If patients have clinical questions, or are experiencing a medical problem, the nurse refers them back to their physician or care provider as appropriate. The nurse will also circle back to the physician team to let them know there was a finding from the call.
"It's a way to connect back to our patients, to make sure they get what they need," says Truneh, who adds that the majority of calls do not require referral back to a clinician. "We see this program as a continuation and a collaboration of care," she adds. "Nurses are the point person, but will filter the information back to the medical team as appropriate."
One of the hallmarks of the SHC program is that it is being done internally, with nurses making the phone calls. Some hospitals hire an outside vendor to make the discharge phone calls, "but we see this program as an extension of personalized patient care," says Aurelio.
At discharge, many patients are so anxious to get home, that they don't absorb all of the information being given to them, says Marlena Kane, director of business development, Patient Care Services. But when they get home, they often have questions.
"Patients may not appreciate the instructions they hear in the hospital as they haven't encountered the struggle with the activity of daily living at home," says Mark Lane Welton, MD, vice chief of staff of Stanford Hospital. "The instructions take on new meaning once the patient is in their home environment. Discharge phone calls give patients an added opportunity to double check instructions, possibly minimizing unnecessary calls to providers and visits to the ER."
Adds Kane, "The ultimate goal is to maximize the patient experience, to do whatever we can to support patients in post discharge care."
By Grace Hammerstrom