Posted on January 14, 2019
One of the largest contributing factors to patients being readmitted to a hospital or suffering a relapse following discharge is their inability to be compliant with instructions, orders and medications provided by caregivers just before they leave.
That can happen for a number of reasons: Patients can't afford to have prescriptions refilled or they forget to take their medications; they didn't fully understand discharge instructions shared with them or they simply didn't wa...nt to be considered a burden by asking questions.
Peninsula Regional Medical Center (PRMC) wants to break down all of these barriers and others that may impede a patient's return to good health. On January 21, it will launch the Care Transitions program in cooperation with NRC Health. Care Transitions is a phone call service that contacts all inpatients and observation patients following their discharge.
Patients receive an automated call that asks them to answer a few simple questions that may include: "Compared to yesterday, is your health today better, worse or the same?" "Do you have questions about your medications?" "Do you have all the information you need to schedule a follow-up visit with your doctor?" "Were you satisfied with the care you received?"
Any negative response or a response that indicates any obstruction to care will immediately be flagged and a specially trained PRMC nurse will contact the person to obtain more information around their concerns. Those will then be forwarded to the appropriate healthcare professional within Peninsula Regional to be quickly resolved.
Additionally, all calls are documented. A dashboard of those calls will help PRMC to better understand the reason for patient concerns, which then allows hospital staff to refine its discharge processes if any trends are discovered. That data provides clinical leaders at the hospital the opportunity to make more real time process improvements.
Care Transitions will not replace PRMC's patient experience survey process, but will complement it and address those small healthcare issues, at home and post discharge, before they become larger problems that are known to impact care and recovery.
PRMC asks that when called, all patients be honest and share with the phone service any issues they feel are negatively affecting their recovery. The program will be expanded on February 25th when all patients discharged from the Medical Center's Emergency/Trauma Center will also receive a similar call checking on the status of their recovery.