By Wendy Smith
A Story of Post-Discharge Compliance
Hospitals are under pressure from Medicare to curb readmissions. Yet, once a patient is discharged, they are outside of the control of the provider. Correlations between social-economic factors have already been linked to readmissions. And, as further studies are done, identification of social-economic elements may help hospitals identify those most at risk. These factors influence behavior and also cause miscommunication by the simple fact that everyone’s life experience colors the way they view and move through the world.
Here’s my personal story. I had a nephrectomy several years ago and was in the hospital for three days. When my urologist was giving me my discharge instructions, he told me that I needed to walk and not just lie on the couch. So upon returning to my home, I talked my neighbor and good friend into walking with me. I could barely sit up by myself, let alone walk, but we went to the end of the street and back, which was about a mile. It was slow going and painful, but we did it again for the next 4 days with my neighbor saying, “I don’t think you should be doing this,” the whole time and me replying that my doctor told me to walk. She made me promise to ask him about this during my follow-up appointment.
At my follow-up appointment, I mentioned my daily walk to my physician. He was horrified that I’d been outside in December shuffling a mile or so a day right after major surgery. He had meant he wanted me to walk to the living room or kitchen or otherwise move occasionally, not hike the neighborhood! I’m a smart girl, but my urologist and I still had a disconnect based on the social factors of age and lifestyle. He told me what he tells any patient after a nephrectomy. But as a runner who exercises frequently, “walk” had a different meaning to me than it does for most of his patients who are much older and probably more sedate. Luckily, our miscommunication did not cause a readmission or complication, but under different circumstances the outcome might have been different. This experience demonstrated to me how easily discharge instructions and other medical information can be misunderstood.
While providers are implementing various discharge programs to ensure compliance and prevent re-admission, many of them are only focused on the higher risk patient and a life style assessment may not be part of that program. A post discharge call back program can initiate contact with all patients, not just those at risk. On the day I received my post discharge instructions, I thought I knew exactly what my doctor’s orders were, yet I was way off the mark and all because of my interpretation of the word walk. If a patient representative or nurse had called me the day after surgery and inquired about my compliance, I would have reported my trek and received corrected instruction the day after my hospital discharge instead of a week later.
Post discharge and readmission prevention programs can review care plans for compliance, determine and escalate a need for intervention and schedule follow-up calls. Outsourcing these types of patient experience and engagement programs often makes sense for a hospital whose staff doesn’t have the time or resources to initiate such a task. Thorough post discharge calls take time and sometimes multiple calls must be made to make contact, which can be very hard on in-house staff. Outsourced medical call centers already have the staff and technology in place to implement patient engagement programs easily and efficiently. And with the stakes as high as they are now, reaching out to newly discharged patients makes sense if for no other reason than to find out if they understand their doctor’s instructions.