Hospital nurses make dial-up ‘house calls’
The Ottawa Hospital has launched a pilot project to improve patient care and reduce the number of people who return to hospital soon after an operation. Its low-tech approach? Have nurses phone patients once they return home to make sure everything is OK.
Q Who does the hospital call?
A Two full-time and two-part time nurses comprise the hospital’s post-discharge team; they call every general internal medicine and surgical patient who leaves The Ottawa Hospital.
Studies have shown that about a quarter of discharged patients suffer some kind of adverse event, such as a drug reaction or infection, soon after leaving hospital.
Q Why was the program introduced?
A Dr. Alan Forster, The Ottawa Hospital’s chief quality and performance officer, says the program was created to improve patient care and reduce the number of people returning to hospital for treatment within 30 day of being discharged. The readmission rate is one metric used to assess the quality of hospitals.
Data drawn from the post-discharge phone calls will be analyzed to understand what’s driving preventable hospital readmissions. Forster says that will allow the hospital to design targeted interventions that address any systemic issues that may be contributing to the problem.
Q What kind of questions do the nurses ask?
A Nurses will ask patients whether they understand the instructions they received during their initial discharge, and whether they’ve encountered any unusual symptoms since arriving home. They’ll also make sure that patients know what symptoms signal potential trouble. The nurses ensure prescriptions have been filled and followup appointments scheduled. They also ask patients if anything could have been done to improve their hospital experience.
The nurses work from a question list and enter relevant answers on the hospital’s computerized patient information system, OACIS. A record of the conversation appears on the patient’s electronic health record.
Q What question elicits the most response?
A Asking patients about their symptoms. Post-discharge nurse Sascha Ménard says patients want to understand whether their experience is normal. What level of pain or swelling around an incision should they be experiencing? In such cases, Ménard asks a series of questions aimed at ensuring there’s no wound-site infection (Is there discharge around the incision? What colour is it? Is there a foul smell when you remove the dressing? Have you taken all your antibiotics?) or dangerous blood clot (Does the swelling go down when you rest? Are you having pain in your calf? Do you have shortness of breath?).
If she suspects a problem, Ménard refers the patient to a clinic, family doctor or, in serious cases, the emergency department. Once, Ménard called 911 when a patient was in obvious respiratory distress on the phone.
Q Why is the hospital investing in improving the patient experience?
A It turns out patients are experts in hospital care. Studies have shown that their collective assessment of a hospital’s overall quality offers valuable insight. “Patients are the best people to give us a sense as to whether care has met expectations: No one else can do that for us,” Forster says.
Improving the patient experience also holds financial implications. Ontario is moving toward a formula that ties hospital funding to not just how many patients an institution treats, but how well they do it. The formula is designed to reward hospitals that provide better patient care at lower cost.
The Ottawa Hospital’s target is to rank among the top 10 per cent of North American hospitals for the quality of its care.
Q Is there evidence that a post-discharge telephone program works?
A Some U.S. studies have shown that a post-discharge program does reduce hospital readmission rates among highrisk patients and patients from low socio-economic backgrounds. But the degree of improvement attributable to such programs remains an open question.
The Ottawa Hospital program is only six months old so there’s no data yet to show whether it has reduced the readmission rate. Anecdotal evidence, however, suggests it has reduced anxiety levels among discharged patients and has succeeded in identifying postoperative issues before they became serious problems.
It has also served as a catalyst for better coordination between the hospital, family doctors, home care agencies and social services. Says Forster: “The more we partner with other people and agencies in our community, the better off our patients will be.”