Can You Decrease Readmissions By 50%?

The June 10, 2014 issue of Hospitals & Health Networks (H&HN) contained the article Technology is the key to patient engagement at the individual level. It is worth reading. http://ow.ly/ylgxZ

It got me wondering about how we define engagement, wondering about engaging patients, and about engaged patients. I think engaged patients are the result of different efforts. Most efforts to engage patients stem from efforts made by the hospital.  They tend to be one-way, from the hospital to the patient. They reflect how the hospital feels its patients need to be engaged.  What they miss by not being two-way is a knowledge of how patients feel they need to be engaged with the hospital.

If the engagement were two-way both the patients and the hospitals would benefit.

I believe technology will be key to patient engagement. I think that designed correctly technology should play a major role in reducing readmissions. I also believe that someone should consider asking the patients how technology could help them.

I recently developed a patient access/experience strategy for the call center of a large teaching hospital. One finding was that 99% of all of the patients who asked to speak with a nurse received a voice mail stating that a nurse would get back to them within 48 hours. Because of my fear of large numbers I did not calculate the cost of those callers who went to ED, but it was orders of magnitude higher than the cost of having a nurse or two in the call center. Most of those who went to the ED did not have an emergency. Many simply wanted a refill.

Let’s look for a moment from thirty-thousand feet at how the discharge process works at most hospitals. When I am discharged I sign my discharge orders, and if I am lucky someone from the hospital calls me in a few days to ask how I am doing or feeling. If someone calls me on day three, and my wound opens on day four, or I am feeling sick, or there is a complication from my treatment or from my procedure or from my medication or from something new, what are my likely responses?

I could call the hospital—see above; I could ignore it; or I could go to ED.

If I was unsuccessful previously calling the hospital, I may not even consider that option. If I call, I might speak with someone who could help me, or I could get a busy signal, I could be put on hold, my call could be transferred, or I could be sent to voice mail—see above. Four of those responses are not good for me, and all five may not be good for the hospital.

Why? If I do not get to speak with someone, chances are that I will solve my problem by going to ED. If I do speak with someone they may tell me to go to ED or to the hospital. Chances are good that the hospital is going to incur a cost and record a visit that may
not have been necessary if the hospital had provided me with a technological
alternative.

What might that technology look like?

I see it working something like this.

Before I am discharged the hospital adds me to their discharged patient portal, an interactive portal that contains information about the specifics of my illness or procedure—my meds, their side-effects, complications that could occur and what I should do about them, symptoms that may arise and what I should do about them. The portal also allows me to input data. I can input that I took my medications and any side-effects I am having. I can input any complications, my diet, exercise, BP and pulse, weight, and any
questions I may have.

The system would be designed to alert someone at the hospital each time any of the data I input is outside of the acceptable norms. This way, instead of me playing doctor and determining what I should do, the hospital can act before I act. They can have someone call me, can send a nurse to my home, or can send a physician to my home.

Not every patient will use this technology, but each one who does will not only be doing themselves and the hospital a favor, they will be more engaged and will have a better overall experience.

 

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