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Using Technology to Ask Questions that Truly Matter, When They Matter Most

May 28, 2013

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Nursing Informatics & Technology: A Blog for All Levels of Users

By: Kathy Levine, RN 

In my first two posts, I examined how nurses are using customized patient education and engagement to help establish a reasonable balance of technology and personalized care to enhance the patient experience and to improve workflow efficiencies. Inherent to this discussion is the reality often overlooked in patient planning and communication: our patients are sick, disoriented, nervous, on medications and, generally, not the best or most effective students, regardless of the intentions. 

When people are ill, they behave differently. I remember being in the hospital for a procedure. I’m a nurse, used to being in the hospital setting and I’m not shy. Yet, with so much going on around me, I felt passive and out of the decision-making loop. Many decisions were being made that involved me and my care, but they were not being communicated effectively. If someone had taken a moment to ask me how I was feeling about my care, and to explain what was going on and why, it would have alleviated some anxiety and could have provided a better overall patient experience. 

Clinicians ask patients a lot of questions, but the communication tends to be mostly one-way, rather than being a collaborative process involving comprehensive feedback. Patients respond to questions, but do they truly understand the inquiry and its implications? Furthermore, will they remember being asked, or recall the direction and guidance they were provided? Patients need to be empowered in the recovery process. As trusted medical partners, we need to ensure that when we give information or ask for input, our patients are coherent, understand what’s being asked or offered, and can provide accurate, reliable answers and follow up. After all, patients with complex healthcare needs account for a high percentage of annual medical expenditures. 

Additionally, with all of the information being provided in this setting, comprehension can be a challenge. Interactive patient engagement systems are wonderful tools, and true interoperability with other hospital systems, such as the EMR, can provide additional focus. By allocating hospital-defined triggers in the administration platforms, clinicians can automate condition-specific education plans to improve patient care and reduce the need for medical services by helping patients and caregivers more effectively manage specific health conditions. These patient engagement systems can aid in simplifying effective, well-rounded care management plans by proactively interacting with patients and family through push messaging and patient-specific education. Furthermore, the use of comprehension assessments reinforces a focused approach to education and facilitates teach back, increasing two-way communication and education retention. 

In short, we can use interactive patient engagement tools to help ensure patients are adequately informed and involved before they leave the hospital, when it matters the most. These tools can be an invaluable resource for reaching out to ask our patients additional questions such as “Are you comfortable with this change? Do you understand the medications you have been prescribed? Do you have questions about your care now, or how to take care of yourself when you leave the hospital?” with the ability to notify clinicians as well as document and track their answers. 

Another valuable feature of patient engagement solutions is “push messaging,” which allows us to ask questions such as, “You received new medications, do you have questions about those medications or when to take them? Has your doctor spoken with you about your care? Did you understand what he or she told you? Do you still have questions?” When these questions are posed through an interactive system on the patient’s television, he or she can view and respond whenever it’s convenient or when coherent, or when there is a family member or other personal caregiver with them. Then, after a patient responds, their care team can review and determine efficient and effective follow-up communications, additional learning, or other required steps. With advances in interoperability, we can also be very specific in the information given and gathered by these systems. We can offer information such as the name of attending staff and contact information, or ask questions about a patient’s satisfaction, pain levels, appetite, or service needs.

Experience has shown that programs that support patient transitions from hospital-to-home were the most successful from both a patient and a hospital perspective. In the value-based purchasing model, once a patient has been sent home, he or she will be surveyed on their patient experience. By reinforcing certain aspects of care, delivering the most effective communications strategy, and receiving patient feedback throughout their stay, the hospital can enhance their quality of care, reduce readmission rates and healthcare costs, while positioning themselves advantageously for patient satisfaction surveys.