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Dial 'H' for Help

Janice Simmons, for HealthLeaders Magazine, September 10, 2009
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This hospital program empowers patients and families while improving quality outcomes.

A diabetic patient admitted to the 202-staffed bed O'Connor Hospital in San Jose, CA, knew her blood sugar was low. The woman, who had been managing her condition for years, was dismayed that her care team—in her opinion—was not adequately responding to her concerns.

But that changed when she dialed "555" from her hospital room phone and the hospital's rapid response team arrived and confirmed that her blood sugar was indeed low. Her medications were adjusted—based on her needs—and her physician was called to let him know what happened. The result: a satisfied and empowered patient and a possible medical crisis averted with the use of a program called "Condition H" (with the H referring to "Help").

Cases in which a rapid response team is needed actually are few and far between at O'Connor, according to Pamela Brotherton-Sedano, RN, who is vice president of patient safety and the compliance responsibility officer at O'Connor. "We've only had three calls [out of 39 total calls] that have warranted the team" since the program was started July 2008, she said. "But it's been well worth it."

While the numbers may be small, the message behind the program is big: patients should have a greater role in their care. "One more way to make [hospital care] fail-safe for us is to have a program where we can let patients speak up for themselves because they know themselves better," Brotherton-Sedano says.

"You can't be dismissive. [Patients] don't lose their rights when they walk through the door. In healthcare we tend to get bossy or [think] we know better," she added. "Yes, we have a lot of knowledge and expertise—but we don't always know better."

The catalyst for the development of Condition H comes from the tragic story in 2001 of Josie King, an 18-month-old Baltimore-area girl, who died after a series of medical mishaps that occurred while she was hospitalized. Her mother, Sorrel King, realizing that better communications among hospital staff, patients, and families could avoid many medical mistakes, created a foundation named after her daughter to promote that message.

King, working with the Institute for Healthcare Improvement, began to speak extensively on improving patient, family, and staff communications during hospitalizations. During one of those presentations in 2005, the chief nursing officer at the 486-licensed bed Shadyside Hospital, part of the University of Pittsburgh Medical Center, heard her message and came up with an idea that became the Condition H pilot project.

Under Condition H, a rapid response team at Shadyside, which consists of a nonteaching house physician, a nurse manager, a bedside nurse, and patient relations representative, could be called if a noticeable clinical change occurred when a healthcare team was not around or if a health staffer failed to respond to the concerns of the patient or family member, says Cindy Liberi, an improvement specialist with UPMC's Donald D. Wolff Jr. Center for Quality Improvement and Innovation. Initially, before the project started, there was concern that patients and families could abuse Condition H—perhaps they would call the Condition H number for bedpans or pitchers of water. This did not turn out to be the case. After piloting it one month on a unit, the initiative was rolled out hospitalwide in mid-2005. By early 2008, all 19 UPMC hospitals in the United States had a Condition H program in place, Liberi says.

The top calls overall received for Condition H from patients and family members at UPMC facilities were for pain control medications, delays in care, or dissatisfaction with staff. The hospitals began to drill down into some of the categories to look at root causes: For instance, Shadyside created a working group to look at issues regarding pain control medications.

At UPMC, and at hospitals across the country that have begun implementing their own Condition H programs, costs have been minimal: No new equipment is required and no additional personnel were needed. Most costs have centered around printing posters or brochures about the program.

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