Creating the journey map identified areas of opportunity to improve hospital processes, one being handoffs from the emergency services center to the medical and surgical floors at 725-bed Tisch Hospital. Around 70% of the system's ER patients are transferred to medical and surgical units. Patients, who may find an ER experience unexpected and disconcerting, often are left to watch passively as clinicians go in and out of their rooms, performing tests and procedures, handing them paperwork to read, sometimes without discussion.
"In a teaching hospital, some inpatients may see 30 different hospital staff in a day; how are they supposed to know what each person did?" Kelly says. In addition, patients can be overwhelmed by receiving dozens of pieces of paper, including brochures, financial and regulatory information, and discharge instructions. "By the time they get to the last piece of paper, they are overwhelmed."
To better engage patients in their care, Kelly is overseeing a pilot program aimed at involving patients in decision-making. As a start, ER and floor clinicians now converse with patients and families about the tests and procedures taking place, explaining why they feel they are necessary and then listening to any concerns or objections. For instance, if a patient questions why he or she has to stay in the ER to have certain tests done, the care team—patient included—can decide whether some or all can be done on an outpatient basis. Physicians are encouraged to bring the family bedside to hear the information at the same time as the patient to avoid any miscommunication.
Kelly also is working with her team to document how patients best receive information—are they more visual or verbal?—and then provide information accordingly. She wants this insight to be part of the patient file so critical information such as transfers, discharges, and medications can be explained in a manner appropriate to the patient's ability to comprehend it. For instance, some senior patients may require 15 minutes to express themselves, Kelly says, so a doctor transferring an elderly patient should set aside the time necessary for them to digest the information and then have input on decisions.
"People are more apt to invest in their own health if we take the time to get to know them and make the information digestible for them," she says.
Kelly hopes that what they learn from the pilot project will be ready to use in the hospital's Helen L. and Martin S. Kimmel Pavilion, an 830,000-square-foot facility adjoining Tisch Hospital that is set to open in 2017.