How Rush University Medical Center Found the Right Prescription for Better Health

By |2018-03-07T15:17:57+00:00June 1st, 2015|

Their new strategy for better healthcare, reduced readmissions, and improved HCAHPS scores.

“We’re all in this together.” Five words that are frequently spoken, but for Chicago’s Rush University Medical Center, it was Fran Jacobs, RN, MS, AOCN, who made the words resonate with hospitalists and patients alike. Jacobs, Patient Education Coordinator in the Department of Quality Improvement, was charged with increasing Rush University Medical Center’s HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores and reducing readmission rates. Her strategy was to provide video tools for the hospitalists to engage better with patients.

Jacobs’ role began with feedback from HCAHPS. Patients felt that hospitalists (doctors who act as the primary care provider for patients during hospital stays) at Rush University Medical Center didn’t provide enough clear information while patients were under their care. We all know how difficult it is to ensure that patients get clear information they can understand and use. Being pragmatic, it’s also important to obtain good HCAHPS scores.

The time crunch

With larger workloads and less time available to spend with patients, and with many patients too sick to retain information, the hospital’s clinical staff was under significant stress. Jacobs recognized that the staff needed support. Studies and data showed patients frequently did not understand doctors’ terminology. Conveying the importance of written and video education, Jacobs began to work with the staff to emphasize quality goals for the whole hospital.

“The Department of Quality Improvement focused on strategies that saved time by creating efficiencies, provided accurate and consistent patient education at appropriate health literacy levels, and met the needs of the patients by increasing their understanding and comfort level.”

The Department of Quality Improvement looked for ways to provide staff with new educational tools and processes. They focused on strategies that saved time by creating efficiencies, provided accurate and consistent patient education at appropriate health literacy levels, and met the needs of the patients by increasing their understanding and comfort level.

“We’re all in this together”

By engaging with the hospitalists under the overarching Department of Quality Improvement, Rush University Medical Center as an institution conveyed the commitment that “we’re all in this together.” Jacobs began to talk with the physicians as a group. She explained the impact of patients’ health literacy levels and explored how to find opportunities for teachable moments, especially with video.

She began to put a structure of support in place. The creation of prescription pages of available patient education videos helped the staff leverage the educational content at their disposal.

Prescribing videos for patient education

With HealthClips® videos on their on-demand television system, Rush University Medical Center’s health care teams began to “prescribe” video education to patients. Jacobs organized the video titles to support individual departments and health conditions including diabetes videos, heart failure videos, and stroke videos. Other videos were categorized for hospital compliance issues such as fall prevention. Subsets of videos on individual topics areas made up a prescription page.

The staff checked off assigned titles and included the prescription in the information folder given to each patient, often making it the first page. Along with the list of video titles and codes, each prescription page included an introductory paragraph stressing three things:

  • the prescription as having been assigned by the health care team
  • how to access the videos on the television system
  • the importance of the information in the videos

Reducing readmissions

Launched as a tool for the hospitalists to help improve HCAHPS scores, the videos and prescription pages also addressed another main focus of the health system. One of Rush University Medical Center’s process improvement goals was to reduce readmissions. Interdisciplinary committees were formed to examine why patients were being readmitted. These groups began tracking readmission focus points.

Recognizing the many social issues having an impact on readmissions (such as a lack of caregiver support and financial concerns regarding medications) the staff began to track all readmission factors. The question of whether patients had received education on their condition and how to manage their health was examined. The video prescription pages provided a solution because they helped the nurses keep track of the education that had been covered with a given patient.

“The Department of Quality Improvement did not anticipate that so many staff members within the hospital would be interested in using the education prescription pages. The program really grew from heart failure and fall prevention to expanding to nearly every department.”

Jacobs explains the rationale, “We wanted to really focus on seeing if we could identify whether there was one key point that really helped patients to be able to follow their plan of care. Our thought was that maybe if they heard that message again verbally from staff, got the same message from written material, and watched certain videos, they might be able to identify what they were doing wrong and understand what they needed to do to get better.”

“The great thing about HealthClips® videos is that all of the take home messages are included in each video. Patients and their families are getting all of those key take home messages in every video and it’s done in such a nice way. People don’t feel like they’re being preached to or that it’s really redundant. The videos are a very good length, very watchable, and the patient gets to hear real patients talk about how they manage their condition. That was really our motivation for putting the video prescription together.”

Implementation in wider circles

When the prescription pages were first made available, heart failure, stroke and diabetes were the primary areas of focus. To ensure continuity across the continuum of care, the nurses checked off the required education and documented it in the patient education section of Rush’s electronic medical record (EMR) system. The nurses gave patients the packet of information and specified the patient education prescription.

The Department of Quality Improvement then added a fall prevention prescription program. In this expanded use, the nurses partnered with physical and occupational therapy. Anticoagulants, hypertension crisis, and breastfeeding were added to the list of available prescription pages.

To make it even easier for the staff, Jacobs added the education information into the clinical side of the EMR for the staff to access and view the prescription pages, the video titles, and the teach-back questions all within the system.

“We had better compliance when we put the titles in EPIC” said Jacobs. “In the patient education piece, the teaching point might be to view videos related to whatever topics (stroke, heart failure, kidney disease). But then under descriptions, I list all the video titles available for that topic with their code numbers. I also write in the instructions and the phone number to call into the system. This has increased awareness of what videos are available on different topics and made it much easier for staff to assist patients with accessing the system.”

Buying into patient education

By engaging with the hospitalists and providing tools such as the pre-packaged education pages, Rush has been able to meet these goals:

  • patients are now being directed to the appropriate videos
  • staff can follow up on the assignments
  • video prescriptions are recorded in the EMR
  • patients feel they are better informed

The nurses found that the video tools reduced readmissions a few percentage points early on, allowing for continuous fine-tuning. Now Rush uses the EMR to identify high-risk patients for readmissions. If patients meet certain criteria, they’re flagged on admission to better manage the social components in play. Nurses feel more empowered to create action plans for patients and they leverage the use of the prescription pages to make sure patients understand the desired behaviors.

Jacobs reports that awareness of Rush’s health television system has risen from 50% to 75% and patients watching health videos has risen from 25% to 60%. There’s a direct correlation in these increases to the use of the prescription pages within the information packets.

Another benefit is the increased involvement of family members. Staff members report that they see family members picking up the prescription pages and engaging with the health education content. Having a care support person or family member involved as an alternate learner is key because patients are often too sick to retain the information themselves.

Jacobs reports that awareness of Rush’s health television system has risen from 50% to 75% and patients watching health videos has risen from 25% to 60%. There’s a direct correlation in these increases to the use of the prescription pages within the information packets.

An expanding and evolutionary solution

The Department of Quality Improvement did not anticipate that so many staff members within the hospital would be interested in using the education prescription pages. The program really grew from heart failure and fall prevention to expanding to nearly every department. It became clear that patients want disease specific information. The staff and the patients like the prescribed list of titles.

However doctors and nurses need to be reminded of the tools available to them. And since new doctors and nurses are always coming on board, they need to be introduced to these support tools. As a solution, e-mail reminders are part of the work flow.

Validating compliance is left to the individual care provider. Clinicians check in with patients to see whether they viewed the videos. Each video includes teach-back questions that help the staff talk with the patient and confirm comprehension. The staff can also view monthly reports of the videos that were watched based on volume.

“When you are talking about using videos as part of the process, we are trying to incorporate that into all of our education documentation tools so that people realize it is part of the process and because people learn in different ways,” said Jacobs.

On an annual basis, the department creates close to 3,000 heart failure packets, up to 1,000 for stroke, 400-500 for diabetes, and about 2,000 for anticoagulation. The total number of prescription pages is not known at this time, but the demand is high.

This is an evolutionary solution. Jacobs has her eye on reaching patients at home by leveraging the web, the EMR patient portal integration, and ongoing staff communication.

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Related:
Rush Ranked Among Top Hospitals in Seven Specialties by U.S. News & World Report