A year into the Hospital of the University of Pennsylvania’s new Patient- and Family-Centered Care Initiative, big changes are in place to help our patients play a more active role in their care, and improve support for their loved ones during stressful -- and often frightening or unexpected -- hospitalizations.
The cornerstone of the initiative is a council of patient and family advisors -- about 15 current and former patients and family members -- who now have a seat at the table for efforts to improve everything from hospital dietary services to the processes with which patients’ possessions follow them through different locations in the hospital, to eliminate the loss of eye glasses, hearing aids, and dentures. Last summer, a HUPDate story introduced members of the patient and family advisors on the council to our hospital community. Garry Nichols, a two-time transplant patient shared his experiences speaking with Environmental Services staff to discuss the special concerns of transplant patients around hospital and room cleanliness:
He explained to the group that, because of the immunosuppressant drugs he must take to keep his body from rejecting his donated lungs, he must be hyper-vigilant about germs. In the hospital, for instance, he avoids restrooms in high-traffic areas, and seeks out those that have paper towel dispensers that operate by waving your hands in front of them rather than touching the sides of the dispenser. The evaluations that the environmental services staff returned after the discussion, Nichols said, were “absolutely incredible,” thanking him for the opportunity to share his story and provide them with such an personal perspective on why their jobs are so important. Mary Walton, MSN, MBE, RN, director of Patient/Family Centered Care, said she hopes to have more of these “story forums” where patients and their loved ones can connect with staff about issues that there’s so little time to discuss during the hustle and bustle of providing care in in-patient units and clinics.
That’s just one success story from the council’s first year of work. Another important accomplishment was the roll-out the hospital’s expanded family visitation policies. That called for bringing in more sleeper chairs so that families can stay close to the bedside overnight, and providing them with food and drink when they're unable to leave the hospital during the cafeteria's off-hours. And another advisor, Carmen Hunter-Anderson, a lung cancer survivor, teamed up with Walton to film a video with the American Journal of Nursing focused on best practices in communication with caregivers of seriously and chronically ill patients.
A newer initiative aims to improve patient and family engagement in the process of planning to go home from the hospital – and start those discussions much sooner during a hospitalization. HUP leaders hope the new processes will eliminate the number of patients who wind up returning to the hospital because of needs that aren’t properly managed at home, or problems that might have been prevented through better communication with patients and families. The efforts are part of ongoing work throughout Penn Medicine to reduce readmissions. Putting patients at the center of "the perfect discharge," as it's being dubbed within the hospital, is the most essential goal, but shoring up the process is important for the hospital, too: Soon, hospitals will soon be financially penalized by the Centers for Medicare and Medicaid Services if they have higher than expected rates of readmission to the hospital among patients with conditions like heart failure, pneumonia, and heart attacks.
Piloted on two floors in the hospital, the new program looks to provide proper time to plan for the struggles patients may face when returning home after a significant illness or injury. The project includes providing patients with a brochure identifying the different members of their care team, including nurses, therapists, and the social workers who will help orchestrate their safe discharge from the hospital. The descriptions even include color coding so that patients can quickly see what type of care provider has entered their room based on the color of their scrubs. And soliciting feedback from patients and their families is a vital component: The brochure includes a sheet that walks patients through questions they may have about recovering at home, including issues with new medications, transportation, meals, special medical equipment, or follow-up doctor’s appointments. Over time, project leaders hope to aggregate the data about patients’ discharge concerns to identify trends, perhaps to develop more programs to address transportation barriers or other issues. Nurses on the two floors are also speaking daily with patients to ask them what questions they have for the day, and writing the queries on a white board in their room to ensure they get the answers they need – long before they’re at home away from the bedside call button to summon help.
Bringing the patient and family advisors into the process for the new discharge planning project has been eye-opening, said Marybeth O’Malley, RN, a clinical nurse specialist who was a project leader on the initiative. Where once their voice was absent from the discussion, it’s now vital: “You really feel as though your hands are almost tied until you have them there,” she said.