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Cullman Regional Medical Center nurses
Nurses at Cullman were an integral part of implementing an initiative to provide patients with recorded instructions.

Spirit of Excellence Award for Patient Safety Winner: Cullman (Ala.) Regional Medical Center

Knowledge is power: Patients' discharge instructions brought to life

By Modern Healthcare
Posted: December 15, 2012 - 12:01 am ET

Studies have shown that patients are 30% less likely to be readmitted or visit the emergency department if they understand their discharge instructions. And in October, the CMS began penalizing hospitals when Medicare patients are readmitted for what the agency deems to be avoidable reasons.

To respond to those challenges, Cullman (Ala.) Regional Medical Center has continued to engage patients after they leave the facility through audio recordings of discharge instructions, as well as videos, images and documents that might help patients or their families better implement at-home care. They're better able to know when and how much medication to take, when to schedule a follow-up appointment or how to dress and care for a wound (which a video can show).

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Within six months of implementing this initiative in October 2011, the 115-bed hospital saw a 7% drop in readmissions among patients who used the communications solution. Hospital Consumer Assessment of Healthcare Providers and Systems survey results also showed a 58.8% increase in staff discussing help needed after discharge and a 59.6% rise in staff communication about symptoms to watch. An in-house survey showed 100% of inpatients found the recordings helpful in managing their conditions post-discharge, while 96% of staff see the solution as being valuable to the patient.

For those efforts and results, Cullman has garnered the 2012 Spirit of Excellence Award for Patient Safety. “One of the main reasons we see that a patient is readmitted usually entails lack of knowledge in taking their medication,” says Paula Burks, director of critical-care/medical-surgical step-down. “Through this technology, we're able to discuss and educate the patient and their family.”

“This is another example of using a fairly simple technology that addresses the primary reason patients either don't understand the discharge summary or don't follow it the way it was presented,” adds Jim Weidner, Cullman's president and CEO. Patients can access any of the aforementioned resources online or call into a recorded phone line to receive the audio.

Physicians loved the idea immediately, while staff came on board fairly quickly once they got past a hang-up about hearing their own recorded voice and realized the new system wouldn't add time to explaining discharge instructions (since they would simply be recording what they were already doing as patients prepared to leave).

Burks adds that when patients complain that instructions were unclear or incomplete, nurses now have the recording to verify what they said. “They were like, 'Oh, wow, this is fabulous,' ” upon recognizing that byproduct of the effort, she says.

But the most important byproduct is patients' greater tendency to tune in, especially when a nurse says, “Can I record this?” Weidner says. “This put a hard-stop into having the patient think, 'This must be important if they're going to record it.' The patient is usually thinking about wanting to go home.”

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