Talking to each other

I’m intrigued by one of Rice Memorial Hospital’s latest care improvement projects – a whiteboard in patients’ rooms for displaying and communicating vital information during the patient’s hospital stay.

It sounds so low-tech and obvious, yet communication is often one of the most difficult things to do well in health care. This is especially the case in hospitals, where the care tends to be more complex and patients and families often must deal with multiple people on the staff. It’s easy for miscues to happen – for instance, weaning someone off oxygen too quickly or overlooking the prompt removal of a catheter. Sometimes patients are never even asked about their own goals for their care while in the hospital.

Many hospitals use whiteboards for keeping track of the patient’s name, the nurse who’s currently on duty, and other basic information. What makes Rice Hospital’s new whiteboards different is the level of detail they contain on the daily goals for the patient’s care. Is the patient on oxygen? Using a catheter? Receiving intravenous medication? Most of these things need to be discontinued before someone is ready to go home from the hospital. The whiteboard is intended as both a summary and a reminder to help expedite the process.

Goals for each patient will be based on the current best evidence in hospital care. Getting patients out of bed for a daily walk, for instance, has been shown to help with the recovery process, and four walks a day appear to be more beneficial than three.

Patient safety is also at stake. In the past, urinary catheters tended to be left in too long, not necessarily because the patient needed a catheter but because it was more convenient for nurses. This practice has been associated, however, with a higher likelihood of infection. It’s hoped that by listing this as a goal for the patient’s care and keeping it displayed on the whiteboard, the care team will have a structured way of communicating and ensuring it gets done sooner rather than later.

The team that developed the whiteboards envision them as a tool for other types of communication as well. For instance, there’s a space to write down information about safe patient handling. Does the patient need a walker or wheelchair? Someone from X-ray who’s bringing the patient downstairs to radiology needs to know this so the patient can be transported safely.

The feature I suspect patients and families will like the most, however, is the space on the whiteboard where they can write down their own questions. In the past, this has been somewhat hit-and-miss. Families can’t always be there to talk to the doctor when he or she is making rounds. Sometimes queries need to be referred to someone else, such as a social worker, and can easily be lost in the shuffle. When families are provided with a structured way to ask questions and have them answered, most of them will more than likely appreciate the opportunity, whether they actually use it or not.

The first few whiteboards were installed last week in Rice’s women’s and children’s unit. Eventually there will be one in every patient room.

The hospital plans to track their success through a variety of ways – patient satisfaction surveys, feedback from physicians and staff, data on catheter-associated infection rates, and length of stay.

On the surface, it might sound like no big deal to implement something like this. In reality, it takes months of discussion and planning to figure out how to do it effectively and work out the details. The concept was even brought before the hospital’s patient advisory committee to gain a sense of whether the public thought the whiteboards would be useful.

This is just one project, it should be noted, out of many care improvement initiatives that are taking place at Rice Hospital (and many other hospitals) at any given time. People go into the hospital expecting that they or their relative will have a quality experience. What they don’t often see is the continual amount of work that takes place behind the scenes to make this happen. To be sure, glitches and complications can occur with any hospital stay. But it’s not an accident when everything goes smoothly and the patient goes home feeling it was a good experience in the hospital.

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