Ensuring the safety of patients after they’ve been discharged from the hospital is a huge concern for healthcare providers. While everyone agrees that the best place for patients to heal is in their homes, not every patient has the support team and ability to manage their post-hospital care satisfactorily.
Depending on the diagnosis, between 17 percent and 23 percent of Medicare patients have to be readmitted within 30 days post-discharge, according to research from the Kaiser Family Foundation. Of course, sometimes readmission is necessary. But in many cases, say the experts, the problems could have been prevented.
So what is being done to help patients stay safe and get well at home?
To find answers to these questions, we’ve been researching patient safety from an anthropological point of view: We’ve been out in the field, observing and talking with patients and the people involved in their post-discharge care. We’ve also taken a macro view and looked into some of the latest reports on patient safety. Here’s some of what we found:
1. Patient education must begin early, continue post-discharge and be comprehensive and practical
An educated consumer, as someone once said, is the best patient. We know from the neurosciences how hard it is to learn new concepts. That is exactly what a person has to do when he or she is being discharged from a hospital setting to recover at home.
One of the reasons for the high number of hospital readmissions is that the system “too often leaves discharged patients to their own devices, unable to follow instructions they didn’t understand,” according to an analysis from the Robert Wood Johnson Foundation.
Fortunately, there are guides to help patients and their at-home avoid this situation. The Centers for Medicare & Medicaid Services (CMS) offers a Post-Discharge Tool that can help patients stay safe. Patients fill in the information with the help of their doctor or nurse before they leave the hospital. Engagement is key to communication. This is not something you just hand to the patient and hope they understand. The tool can then be displayed at home where everyone can see it and use it as a checklist to ensure daily activity adheres to the necessary care.
The National Patient Safety Foundation also has a useful educational pamphlet in the form of a checklist that can help patients and their caretakers stay on top of the steps they’ll need to take to get well.
When educating patients, it’s important to remember that while they may understand what they have to do in theory, they may not be able to put the instructions into practice. One woman we encountered had surgery on her back. She had a catheter that needed to be cleaned regularly but when she got home, she discovered that her husband couldn’t follow the instructions and she was dependent on the nurse who came. Her stress was profound--less about the catheter and more about being unable to care for it.
Healthcare professionals need to think ahead about potential problems and come up with practical solutions.
2. Relationships rule
One often-overlooked key to safety is making sure that the patient has an open and caring relationship with his or her caretaking team. Staying connected--through face-to-face follow-up or modern communication technologies--is essential. Patients may feel confused, overwhelmed, anxious or weak, especially during the first few days at home. They may not even know what questions to ask.
Sometimes, patients or their family members just want someone to talk to. They want someone who can help them find answers to questions or deal with unexpected challenges.
One family we spoke with was concerned about their father, who lived alone. The family had hired a home health aide to care for him post-discharge, but often, when they came to visit, they’d find her watching TV while the father sat slumped in another room. They knew that all this sitting around and lack of stimulation wasn’t helping his recovery, but they didn’t know how to fix the situation.
In another case, we listened to older adults in their 70s and 80s repeatedly tell each other and our client that they didn’t need time with the doctor. Instead, they needed time with someone who could tell them what their doctor said. Their “safety counselor” was missing along the entire continuum of care.
3. Caregivers need training and support
Home care nurses do more than just care for patients. As the National Association for Home Care & Hospice Nurses points out, “they also teach patients to care for themselves, and this isn’t always easy.” There may be cultural or language barriers that make communication hard. Nurses may have to educate family members, and this takes time and trust. Clearly, home care nurses must have special skills and they, too, need to see their roles beyond that of providing the technical care.
The federal government has started rating home health agencies to address the problem. But this feels like a big black hole waiting for some way to address it.
“Poor transitional care is a huge, huge issue for everybody, but especially for older people with complex needs,” Alicia Arbaje, an assistant professor at the Johns Hopkins School of Medicine in Baltimore, told Kaiser Health News. “The most risky transition is from hospital to home with the additional need for home care services, and that’s the one we know the least about.”
Andrea J. Simon, Ph.D., is a former marketing, branding and culture change senior vice president at Hurley Medical Center in Flint, Michigan. She also is president and CEO of Simon Associates Management Consultants.