#teachback

By Aine Cryts

Increasing patient engagement

If healthcare providers wait until the day of a patient’s hip or knee surgery to worry about preventing readmissions, they’ve probably missed the boat, says Anthony DiGioia, MD, founder and medical director of the Patient and Family Centered Care Methodology and Practice Innovation Center at the University of Pittsburgh Medical Center (UPMC).

That’s why the medical center considers all of the processes that touch patients—from presurgical preparations such as lab testing to the surgery and the patient stay to the patient’s rehabilitation—and keeping in mind the perspective of patients and their families as they design patient care. Keeping the patient’s perspective in mind helps drive higher patient engagement, which, along with family engagement, is the best way to reduce readmissions and improve outcomes, insists DiGioia, who is also a practicing orthopedic surgeon.

DiGioia notes that patient falls—either in the hospital or at home after surgery—are of particular concern to patients and their friends and families. In response, UPMC uses the following approach, which is heavily reliant on patient engagement, to help prevent readmissions among its total hip and total knee replacement patients:

Educating patients three or four weeks before their surgery about what to expect;

Coaching patients to start their post-operative exercises three or four weeks before their surgery;

Teaching patients about the medical center’s falls prevention program; and

Encouraging patients to select a family member or a friend as a “coach.”

Put nurses back in the classroom

Newton-Wellesley Hospital, which is located 13 miles outside Boston in suburban Newton and is part of Partners HealthCare, took 20 of its nurses out of the hospital and sent them to a conference organized by the Cambridge, Massachusetts-based Institute for Healthcare Improvement (IHI), a nonprofit focused on driving healthcare improvement worldwide, to learn about ways to improve patient care.

One of the tools the nurses brought back to their patients was the “teach back” method, which involves nurses educating patients about what they should be doing once they get home after being discharged from the hospital, and then asking patients to explain those instructions in a way that the patient understands, says Bert Thurlo-Walsh, RN, vice president of quality and patient safety.

For example, nurses tell congestive heart failure patients that they need to be careful about eating foods with high salt content, as these foods may cause them to retain water and then have trouble breathing, says Thurlo-Walsh. Patients are also advised to monitor their ankles for signs of weight gain. Patients are then asked to explain what this dietary advice and monitoring of health signs means to them, says Thurlo-Walsh.

These conversations, which were once driven by a paper-driven work flow, are now built into the hospital’s EHR-driven work flow—and that alone has had increased compliance from less than 50% to more than 90%, says Thurlo-Walsh. Newton-Wellesley’s readmissions rate for all surgical procedures has gone down from 11.4% in 2012 to 10.8% as of April 2016, according to the hospital.

By Stella Hart

Research shows that patients retain only 20 to 60% of the health information they are given, and only half of that is accurately recalled. Teach-back is an educational method that healthcare providers can use to help their patients truly comprehend and retain health information.   

“[Teachback] is a method relating to teaching, it is the evaluation of understanding,” explains patient education expert Fran London. “If the learner falls into the lowest levels [of understanding], we need to re-teach in another way so the learner understands well enough for safe self-care after discharge.” 

Healthcare providers should encourage patients to explain, or “teach-back,” information in their own words. X-Plain can help patients of all literacy levels establish a knowledge base about a health topic and facilitate the teach-back process.

Back in the Parkes building with Andy; at the moment reviewing any learnings and applications in the real world. Few people had some instances were they asked “why is this a problem?” and uncovering that there wasn’t really a problem. Key is remembering the 4 Ps: - people - place - process - press

Overview of the days 4 & 5: first a quiz, then teach back and also a two hour final prep for our practice sessions.

Start the quiz - and we are quite rusty! Some of the questions seem hard but once the answers are said, they appear like a forgotten language.

Now into the teach back seasons, Andy starts us off on Understanding the Challenge. Interesting anecdote about all cars being black at the start - but they weren’t sure how to apply non-black paint to metal, and one picked up the method from a toy shop. Leadership team wasn’t buying it - but when they were in a conference he painted their cars different colours. Innovation takes creativity and courage.

We’ve just listened to brainstorming teach-backs (vanilla, with post-it’s and enhancers) and now Alison is doing brain-writing. Quick break before the second session of teach-backs.

Now refining to the sessions, first with the ladder of abstraction starting with breaking down tasks. Key is asking the how, why and why else questions. Next is the morphology matrix, focusing on 3-5 key parameters as columns for generating options.

Just done mine - didn’t go as well as I’d planned but not the worst. The best ones were the ones that used the boards in an original way (Stephen did his as a massive Homer Simpson) or technology (iPads) for prompters, music and images.

Short, Medium and Long was just presented: actually quite interesting and think it’s something that I would actual use both in the practice sessions and in the real world.

Next up is Evaluation matrix, PCO (priority comparing options) and ALUo. PCO is a bit tedious but can effectively tee-off an option against others. ALUo: advantages, limitations, unique qualities and overcome limitations) helps you think more clearly about ideas, with judgement. Now time for a well-earned lunch!

We had our first CPS session - went quite well and was quite interesting. I’ve got mine tomorrow and it’s a little daunting. Now we’re just reflecting on the first session before we wrap up.