As John readied himself for discharge from Boston University Medical Center, a pretty, brunette nurse named Elizabeth approached.
Dressed in a pink shirt and blue scrub pants, she showed John his discharge plan, reminded him of the medicines he was prescribed for after his hospital stay, and gave him the name and phone number of his post-hospital doc. She added one more thing: “So, are you a Red Sox fan?”
John said yes, so Elizabeth responded.
“I would really like to see a game someday,” she said. “But they don’t allow computers at Fenway Park.”
Elizabeth is an avatar, placed on a bedside, touch-screen computer, and tasked with one thing: helping John. She’s part of Project Re-engineered Discharge, a transitions of care prototype that uses novel health technology to enhance patient safety and communication upon discharge, project researcher Suzanne Mitchell told the 2013 Transitions of Care conference audience Friday.
“This was to try and help the nurses on the hospital floor do discharge more efficiently,” Mitchell said. Elizabeth doesn’t replace the nurse, but complements him or her, allowing them to dedicate time to more critical patients.
It’s not the only portion of Project RED, but it’s certainly the flashiest. It’s couple with dozens of other initiatives aimed at reducing readmissions: phones calls two days after discharge to ensure proper care, reviewing medications and appointments with patients, providing language services for non-English speakers, among many others. After spending hours, days, or weeks in hospitals, the average discharge conversation lasts eight minutes, Mitchell said, not nearly enough time to fully explain the continuum of care.
Dr. Joseph Ouslander, a chairman at Florida Atlantic University’s medical school, is working to achieve the same thing. His program—Interact—started out as a toolkit for providers, but has transformed into a full-fledged quality improvement program. It’s designed to improve the care of nursing home residents during acute changes in condition, and includes evidence and expert-recommended clinical practice tools, and strategies to implement them.
“The goal of Interact is to improve care, not to prevent all hospital transfers,” he said. “Because you can’t, unless you tie [patients] down in four-point restraints.”
Interact has three strategies:
– Preventing conditions from becoming severe enough for hospital admission, by identifying them early
– Managing some conditions in the nursing home, without transfer to the hospital
– Improving advance care planning and the use of palliative care plans when appropriate
The program—which uses a combination of tech and human interaction—was tested in 25 facilities, and lowered readmissions by 17 percent. In nursing homes that fully-committed (and didn’t cut corners, Ouslander said), the number was 24 percent.
“What we try and say is this is a quality improvement program, so in order to improve something you have to have a team, have to measure something consistently,” Ouslander concluded. “So the communication skills are fine to start with, but it’s really just a part of the program.”