first 24 – 72 hours after heading home, the experience is still fresh in a patient’s mind. By calling patients proactively, you demonstrate having their best interest in mind and wanting to gain information that will not only help you repair your relationship with them but also make changes before problems become widespread.
The bottom line is it really all comes down to trust. You think you’re in the healthcare delivery business—you deliver medical services, make people better, and send them home. But it’s important to remember that you’re really in the business of trust. When people enter your hospital for care, they are placing their trust in you. That is the sacred bond you enter into with your patients. And you can never forget how sacred and fragile patient trust is. PD calls give you an opportunity to solidify a trusting relationship.
Everybody Wins
Many healthcare organizations have mission statements that speak to care, compassion, service, and quality. Part of living your mission or promise comes down to how you manage the entire patient relationship, including after discharge. People’s needs and vulnerabilities don’t stop as they are wheeled over the threshold or drive away from your campus. In their minds, they are your patients. It’s important to foster that relationship.
Regardless of the main reason you start a PD call program, hospitals have found that they benefit across all areas. Patients often appreciate being asked for their opinion. It makes them feel valued and appreciated. Whether their feedback is positive or negative, patients appreciate being asked. The very act of asking is good public relations and can cement a positive, lasting impression.
PD calls impact clinical outcomes by addressing medication questions and new or worsening symptoms. Calls can improve discharge teaching and clarify discharge instructions, improving patient satisfaction and avoiding costly readmissions. Providing a personal touch point within days of discharge can also help you identify star performers for recognition, understand any deficiencies in your system, and give patients a chance to answer the question, “How did we do?” They feel valued, and you get valuable insight. Everybody wins.
Chapter 2
An Integral Part of the Care Continuum
Preparing patients for discharge starts at their times of admission. Nurses have always embraced a concept called “anticipatory guidance.” It refers to what we can do to guide the patient through what to expect during his entire hospitalization and discharge. This preparation can start the time of admission or even earlier for admissions associated with scheduled procedures.
The key to creating a positive discharge experience lies in managing the patient experience along the entire continuum of care. A well-orchestrated discharge plan is one that begins early and is reinforced throughout the entire hospital stay. One stellar example of this is with total joint surgeries. Evidence-based medicine has created a high degree of predictability that allows a healthcare entity to begin the discharge plan weeks before the admission occurs. Because the pathway is predictable, there have been excellent programs developed to help patients prepare well in advance of their surgeries about what to expect. Patients often attend classes, learn about rehab, and even have a home health visit prior to admission in anticipation of their discharge and recovery.
Something to take forward as you think about PD calls is that the whole experience with discharge starts early on in the overall encounter. If you could do one thing in healthcare that would make such a huge difference in the care and outcomes with your patients, it is this: every patient who comes in contact with you and your providers should leave more informed, more educated, and more confident than when he or she arrived. PD calls fit hand in glove with this goal because follow-up calls continue the relationship with information, education, and reassurance that builds the confidence patients so desperately need.
Some of my recent focus groups with patients affirm that their needs don’t stop just because the discharge has taken place. Their need for follow up is crucial from numerous perspectives. It is clear that an effective discharge should include four essentials:
1.Manage patient expectations
2.Use key words in communication to reinforce crucial information
3.Leave the patient or caregiver crystal clear about next steps
4.Include a follow-up plan
The next section expands on these four ideas.
Discharge Essential #1—Manage patient expectations
Managing expectations is an appropriate goal in numerous encounters along the patient experience pathway. Whether or not we’re talking about discharge, wait times, or what a procedure will entail, it’s important to tell patients what to expect so they can better prepare.
One example of such a conversation would be to say, “Ms. Baird, you need to come back in seven days to get your stitches out. In the meantime, I’m going to show you how to take care of the incision at home. I’m going to talk you through it, and I will also give you written discharge instructions that you can refer back to at home.”
Another example is, “Somebody’s going to be calling you within two days after you get home to check in with you. She’ll review your discharge instructions, medications, and see how you are feeling.”
By having this type of conversation, you’re giving the patient and caregiver a head’s up about what kind of timeframe they’ll be dealing with and the purpose of the expected follow-up call.
Using the example of joint replacement, another thing you might say to manage expectations before admission is, “The average stay in the hospital after a total hip replacement is about three days. I’m going to be explaining to you, step by step, what happens during those three days and what we’ll be doing during that period to help you prepare for your discharge.” This process manages patient and family expectations and helps them prepare for what lies ahead.
The idea here is that, all the way through, you’re managing expectations from the pre-op visit, actual admission, discharge instructions, and to following up at home.
Discharge Essential #2—Use key words
Using key words during discharge discussions is an effective communication technique used to reinforce crucial information. It has become a common practice in many healthcare settings, particularly in patient education. Using key words during your discharge discussions is important in reinforcing important information printed on the discharge documents, but those key words are also terms they’ll see on the survey. Please note: you want to reinforce what’s on the survey, not ask the questions that are on the survey or sway the patient’s answers.
It can be extremely effective to use some of the same words in your follow-up discussion that the patient will see on the survey. You might say, “I’m reviewing these instructions so you know how to care for yourself at home.” Another statement might be, “I’m going to review symptoms or health problems to watch for during your recovery.” By using these phrases, you are helping to raise the patient’s understanding.
You can further reinforce the message by making sure whatever documents you distribute to the patient use the same terminology as the verbal discussion. If you use the term “discharge instructions” in your conversation, make sure the written instructions are clearly labeled as discharge instructions. I’ve seen many beautiful presentations, including folders
