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Greetings!
Welcome to the first edition of the Care Transitions Monthly Briefing!
You are receiving this newsletter as a result of your participation in the Patient Centered Care in Action - Care Transitions Learning and Action Network, or simply for your involvement in care transitions in your setting. Each month, this briefing will include a variety of information on different topics, tools and resources, upcoming trainings or events and your improvement stories.
We hope you will find this briefing to be a valuable resource as we work to reduce readmissions and improve care coordination for patients. |
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 Why Teach-back?
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A large number of hospital readmissions can be avoided with simple communication about patients' after-hospital care instructions, including how to take their medicines and when to make folow-up appointments (if not already scheduled upon discharge). Healthcare professionals should ask patients to explain in their own words the details of the discharge plan (the teach-back technique). Teach-back does take a little more time but studies show that the long term benefits far outweigh the efforts. Patients who have a clear understandŽing of their discharge plan are 30 percent less likely to be readmitted or visit the emergency department than patients who lack this information.[1] Many studies have shown that 40-80 percent of the medical information patients receive is forgotten immediately and nearly half of the information retained is incorrect. One of the easiest ways to close the gap of communication between healthcare professional and patient is to employ the "teach-back" method, also known as the "show-me" method or "closing the loop." Teach-back is a way to confirm that you have explained to patients what they need to know in a manner that they understand. Patients' understanding is confirmed when they explain it back to you. Teach-back best practices
- Not a test of the patients' knowledge: Teach-back is a test of how well you explained the concept. Ask patients to repeat in their own words what they need to know or do, in a non-shaming way. - Example: "We covered a lot today about your diabetes. I want to make sure that I explained things clearly. Let's review what we discussed. What are three strategies that will help you control your diabetes?"
- Used with all patients: Use teach-back when you think the patient understands and when you think someone is struggling with your directions. Some successful facilities have added teach-back questions to their standing orders.
- Clarify: If patients cannot remember or accurately repeat what you asked them, clarify your information or directions and allow them to teach it back again. Do this until patients are able to correctly describe in their own words what they are going to do, without parroting back what you said.
What kind of information should I include during teach-back?
The following two tools have been well studied as excellent resources for discharge. The information in either can be used during teach-back.
If you want to download or print this article, please visit the HealthInsight website at http://www.healthinsight.org/Internal/CareTransitions.html
[1] Brian W. Jack, MD, Veerappa K. Chetty, PhD, David Anthony, MD, MSc, et al, "A Reengineered Hospital Discharge Program to Decrease Rehospitalization," Annals of Internal Medicine 150(3), Feb. 3, 2009, pp. 178-187, http://www.annals.org/content/150/3/178. abstract
[1] The Teach-Back Method: A Better Way to Patient Compliance and Understanding, Robert Glatter, MD, Emergency Medicine, 08:12PM Aug 16, 2012 http://boards.medscape.com/forums?128@175.C9SIapvbjfd@.2a342864!comment=1
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Care Transitions is a Team Sport |
"Care transitions is a team sport, and yet all too often we don't know who our teammates are, or how they can help." Eric Coleman, MD, MPH
Transitional Care is defined as "a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care within the same location." Typically, these locations are hospitals, long-term, and sub-acute facilities, and home with or without home health or hospice services. Transitional Care often involves an inclusive array of admission and discharge planning, logistical arrangements and coordination, and patient and family education. Transitional care is bidirectional, as it involves both sending and receiving information about patients' needs, care preferences, clinical status, and goals.[1]
Numerous studies demonstrate that care transitions have significant potential for error due to the number of people involved, internal and external communication break-downs and misunderstandings, and last minute patient status changes. Ineffective care transitions often result in patients being readmitted to hospitals, negatively affecting patients' health and well-being, and increased health care costs.[2][3] Fortunately, studies now show that an integrated, organized community program can improve the quality and safety of patient transitions.[4][5]
We need your support, expertise, and experience to identify strengths and overcome weaknesses in existing care transitions processes and protocols. Together, as a community, we can improve patients' outcomes.
We invite you to become an active Care Transitions Community Partner by contacting me, Larry Garrett, at HealthInsight for additional information on training and event opportunities. We depend upon you to help shape care delivery capacity in Utah by providing us with feedback, ideas, and joining in teams or collaboratives, ETC.
[2] Transitional Care Model retrieved from
[3] Best Practice Intervention Package: Fundamentals of reducing acute care hospitalization. West Virginia Medical Institute. Retrieved from the HHQI Website at
[4] Care Transitions Intervention. Retrieved from
[5] Coleman EA, Boult CE on behalf of the American Geriatrics Society Health Care Systems Committee. Improving the Quality of Transitional Care for Persons with Complex Care Needs. Journal of the American Geriatrics Society. 2003;51(4):556-557. |
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About Our Work |
This information is provided by HealthInsight, a private, non-profit, community-based organization dedicated to improving health and health care. HealthInsight serves as the Medicare Quality Improvement Organization in Utah and leads an initiative to improve care coordination and reduce hospital readmissions across settings of care.
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Sincerely,
Larry Garrett, HealthInsight
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| Local Events | |
No local events listed at this time. |
| National Events | |
National QIO Learning & Action Network Confer-ence Call/Webinar Series
"Building Blocks of
Quality Improvement"
Every 2nd and 4th Thursdays
Upcoming:
Wed., October 10, 2012
1:00 - 2:00 pm MT
Continuous Quality Improvement at the Heart of Organizational Change
High performing organizations share how they changed their organizations from the inside out and the results that followed. Learn what it means to utilize continuous quality improvement.
Visit the HealthInsight website for more information.
Quality of Care
Transitions:
Tools and Resources Webinar
Fri., November 2, 2012
9:30- 10:45 am MT
Learn how to assess the gaps and barriers for improving transitions in care ; identify key interventions for quality care transitions; and review tools and resources for healthcare professionals and consumers in improving care transitions.
Visit the Health Sciences Insitute registration webpage for more information. |
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| Feedback | |
Please let us know whether you found this month's edition useful, or if you have suggestions for the focus of future articles.
We are sending you this monthly publication to spread the news about local care transitions efforts and to inspire you to keep up the good work.
Please feel free to forward this publication using the "Share this" button at the top right corner. Each edition will also be archived on our website.
You may unsubscribe to this newsletter at any time by e-mailing me your request. |
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