Studies have demonstrated that patients forget 40%–80% of the information they receive almost immediately after hearing it. In addition, nearly half of the information they retain is incorrect. Given the importance of understanding one's disease process and follow‐up, this adversely affects patient outcomes. Patients who do not clearly comprehend their disease state or postdischarge instructions may decompensate before seeing their primary care provider and subsequently get readmitted. National readmission rates for Medicare patients are around 20% and for some diseases like heart failure are closer to 23%. A multidisciplinary team was convened to develop a process to improve patient education and affect outcomes.
To develop a patient education strategy for patients admitted with a primary diagnosis of heart failure.
A multidisciplinary team is using Lean methodology to improve the efficiency and quality of care transitions. A smaller subgroup is examining the role of patient education in these transitions. This group identified the teach‐back concept—using humble inquiry to gauge a patient's understanding of the patient education process—as a potential tool to improve outcomes. The team piloted the use of teach‐back on heart failure patients on a medical–surgical unit. Patient and nursing education colleagues developed a series of questions related to heart failure and its treatment. Patients are asked these questions over 3 days, sequentially building on the previous day's material. The questions were programmed into the computer‐assisted physician order entry system, providing both a prompt and a framework for the questions to the bedside nurse. A training video was developed and placed in our e‐Learning system. More than 1400 nursing colleagues have completed this learning module thus far. Press Ganey data are being tracked to gauge patient satisfaction with teach‐back. Analysis of the intervention is promising. In the first quarter of FY11, 180 unique heart failure patients had teach‐back. The readmission rate for those patients was 7.29%, with a length of stay of 5.14 days during the second hospitalization. A total of 289 unique heart failure patients did not receive teach‐back during the same time frame. The readmission rate for these patients was 9.66%, with a length of stay of 6.87 days during the second hospitalization. Additional teach‐back questions are now being developed for community‐acquired pneumonia, stroke, myocardial infarction, anticoagulation, hypoglycemia, and chronic obstructive pulmonary disease.
Teach‐back is a general concept that can be applied to multiple disease states. The concept can be taught and spread throughout a hospital or network relatively quickly. Teach‐back may have a positive impact on patient satisfaction and appears to have the potential to positively affect readmission rates by improving patient understanding of their disease process.
M. Pistoria ‐ none; D. Peter ‐ none; P. Robinson ‐ none; K. Casey ‐ none; M. Jordan ‐ none; S. Lawrence ‐ none