Background:

Preventable rehospitalizations are disconcerting for patients, contribute to high health care costs, and are partly due to deficiencies in patients’ ability to execute the posthospital care plan. Effective patient and family care‐giver engagement and education can improve patients’ ability to carry out the posthospital care plan and may help to reduce preventable rehospitalizations. We identified several inadequacies in the patient engagement and education process for our general medicine inpatients and convened a multidisciplinary team to address this issue.

Purpose:

To improve the quality and reliability of general medicine inpatient education in order to improve patients’ ability to execute the posthospital care plan.

Description:

This effort was piloted on a 30‐bed general medicine unit (2000 annual discharges) in a 775‐bed urban teaching hospital. A multi‐disciplinary team comprising frontline nurses, nurse administrators, nurse educators, hospitalists, unit secretaries, and performance improvement staff met regularly during 2010 to review existing patient education practices, identify opportunities for improvement, conduct small sequential tests of change using plan‐do‐study‐act (PDSA) cycles, create tools for structuring and standardizing the patient education process, audit performance, and provide feedback to staff using “run charts” of performance data. The first change idea to be implemented was to reliably identify and document the “primary learner” (either the patient or a family caregiver or both) and share this information with other involved clinicians. To accommodate the substantial heterogeneity among our general medicine inpatients, we developed a standardized template to address 4 key areas for patient education: principal diagnosis, major testing or treatment, danger signs, and focused disease‐based education where appropriate. Hospitalists, house staff, and nurses were asked to communicate about all 4 areas during daily morning rounds so that a consistent educational message could be passed along to patients each day. Based on initial experience, “teach‐back” (having patients repeat back what was taught) was subsequently introduced in order to ensure adequate understanding of the educational message.

Conclusions:

It is possible to develop a structured and reliable process for inpatient education in a heterogeneous general medicine inpatient population. Through a series of PDSA cycles, we were able to increase the reliability of “primary learner” documentation to > 80% (Fig. 1). Efforts are under way to include “primary learner” documentation in our hospitalist sign‐out template and to develop an appropriate measurement strategy for patient education (using “teach‐back”) in the 4 key areas outlined above.

FIGURE 1. Percentage of patients with “primary learner” documented in medical record

Disclosures:

O. Hasan ‐ Lilly, adviser; P. Aylward ‐ none; R. Zaremski ‐ none; A. Furey ‐none; S. Bartelt ‐ none; J. Brandl ‐ none; S. Imparato ‐ none; L. Meeker ‐ none; S. Rounseville ‐ none; K. Wickman ‐ none