Ensocare - Topics on readmissions, discharge process and improving patient care

Empowering Patients to Engage and Follow Care Plans Post Discharge

Written by Mary Kay Thalken, RN, MBA | 4/11/16 2:00 PM

As health care has evolved, the patient’s role in following his or her care plan after discharge has increased, and hospitals need to find ways to help patients help themselves. According to The Advisory Board Company’s Annual Health Care CEO Survey, 45 percent of hospital executives are interested in identifying patient engagement strategies. It’s no secret that engaging patients in their care is essential to care quality, increasing patient satisfaction and, ultimately, achieving positive outcomes. However, when the patient leaves the hospital it can be a challenge to sustain patient engagement, especially when it comes to maintaining communication and overseeing care continuity.

Though patient and family engagement can be tough once a patient is out of sight, there are ways to facilitate communication, continue oversight and ensure patients follow established care plans.

Let’s start at admission. Whether an inpatient stay is the result of an office visit or a trip to the emergency room, patients typically don’t expect to be in the hospital. They may be confused or emotional and may not fully accept or understand their condition. A patient’s understanding and acceptance of his or her condition is the foundation of involvement in post-acute care. Therefore, it’s essential for hospital staff and physicians to communicate with the patient and his or her family about the diagnosis in an effective and timely manner.

When it’s time for discharge, patients and their families may feel helpless, so getting them directly involved in care decisions and transitions is one way to keep them engaged and empowered. This is also an important component of long-term patient satisfaction. New care transition technology offers bedside touchscreen tablets to effectively connect patients with post-acute providers before discharge. Patients can view and compare facility profiles, photos, videos, patient reviews and quality ratings. This type of detailed information allows patients to virtually tour facilities and make an informed choice before their departure process reaches a pressure point.

Care transition is one of the most critical times to communicate with patients and families, as patients may forget earlier instructions or find it difficult to change long-held routines and habits. Many patients need support to follow their care plans and rely on family members to manage prescriptions and other aspects of their health-care needs. The family plays a vital role by offering emotional support and reinforcing treatment plans and healthy lifestyle decisions. For these reasons, it’s important for the patient and caregivers to be fully informed and know what is expected. This helps to ensure the patient continues on the path to recovery and achieves better outcomes.

Technology can make it easier for hospitals to keep patients, families and providers focused on individual patient goals, but it can’t do the job alone. Communication platforms can offer support to patients and families by sending educational information and care plan reminders and providing tools to track the patient’s recovery. Hospital staff can use the time savings that care coordination technology delivers to interact with patients and intervene as needed when crucial milestones in the care plan aren’t met.  I understand that hospitals have limited time and resources, and taking the time to educate patients and families about care transitions can be challenging. But there are resources to help. Read a blog from one of my colleagues about how care coordination technology enables hospitals to focus on higher risk patients and family engagement, to promote better outcomes.