Using health IT to improve patient engagement and communication

CHICAGO—“First do no harm,” Patricia C. Dykes, PhD, RN, senior nurse scientist and program director of the Center for Patient Safety Research and Practice and the Center for Nursing Excellence at Brigham & Women's Hospital in Boston, reminded her audience at the 2014 Healthcare Leadership Forum in Chicago. “Yet, 400,000 patients are harmed each year.” Ineffective communication is a leading reason for these errors. Dykes’ covered ways providers are using technology to engage patients, their caregivers and families to achieve more successful outcomes and reduce errors.

The need for patient-centered care is obvious, but providers need tools to promote better patient engagement.

Patient activation is a necessary prerequisite to patient engagement. According to Dykes, there are four stages of patient activation:

• Believing the patient role is important
• Having the confidence and knowledge necessary to take action
• Taking action to maintain and improve one's health
• Staying the course even under stress

From a study by Hibbard & Green (2013), What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs Health Affairs, Dykes explained that engaged patients are more likely to: engage in preventive behavior (check-ups, screenings and immunizations), engage in healthy behavior (healthy diet, regular exercise) and avoid health-damaging behavior (smoking and illegal drug use).

Working to engage with patients, families and caregivers has been proven more effective than dictating treatment. Dykes presented research from several fall prevention studies where patients and families were engaged, and results from a randomized clinical trial in which in-hospital falls were reduced for patients, especially those identified at risk of falling and over 65 years old.

Dykes explained the thinking behind her two-year mixed methods study funded by the Robert Wood Johnson Foundation. The qualitative phase considered why hospitalized patients fall, as well as what interventions are effective and feasible in hospital settings. In the randomized control trial, her team designed a toolkit to address issues identified during the qualitative phase.

Her team determined the communication surrounding fall risk status and the plan of care in the hospital setting is highly variable. They also found inconsistent communication across team members a barrier to collaboration and teamwork, and other team members do not view the plan as detailed in the medical record, and that there was inadequate, incomplete or incorrect information at the patient’s bedside.

With the assistance of team communication, leveraging existing workflows, using health IT tools such as surveillance and customized communications, the team was able to reduce the number of in-hospital falls.