Hello, my name is Cheryl Christoffi, and I'm a coordinator nurse for a cardiac surgery program at Bay State Medical Center in Springfield, Massachusetts and Just a little bit about my role I am I help patients be prepared for surgery by making sure they have all the information They need and make sure that they are having safe transitions and the best possible Transitions of care throughout that perioperative period in including when they go home so just like Shannon We're looking at how we can impact inpatient and outpatient And I want to thank the Society of critical care medicine for the honor to speak today on my topic Which is patient reported outcomes and patient engagement These are my conflicts of interest The objection the objectives of this presentation are to discuss the challenges related to patient engagement I'm going to be sharing some strategies to overcome some of these challenges And I'm going to be outlining some methods that you can use or that we're using to collect patient reported outcomes To customize and improve our patient care So a little background we're all used to traditional patient surveys these really assess How pleased or displeased a patient is with a health care encounter? So you're going to find out how they interacted with your institution as a whole Whereas pros give you valuable insight into how well patients progressing after a health care encounter And what is really important to them regarding their health care? So examples of what we find valuable are pre-op does the patient know when to stop medications? Do they know where they need to go the day of surgery those kind of things while they're in the hospital? We want to know are you walking? What are your barriers to walking? Are you anxious about going home? What's making you anxious about going home when they're home? How's that weight trend going? Are you retaining fluid are we? How's your wound healing so those are some examples of the pros that we're interested in? Step one is making sure they're helping our engage with our patients is making sure our team is engaged So we all have to be on the same page We all need to say the same things we need a team approach that means your team has to meet Has to know what is the information that the patient is receiving and be up-to-date if there's changes So a surgeon says one thing the anesthesiologist needs to say the same and so on and so forth We all have to be together for our patient to be Able to know what they need to do to be successful. So some of the challenges that we face Are and there's many but I picked out some that we find often which language barriers Low literacy levels and limited health literacy in workforce instability I'm really going to focus a little bit on the health literacy because I think we Underappreciate how frequent this occurs in our patients and this is when patients Health literacy is defined as the ability to obtain Medical information and to obtain the services they need and to understand that information So we under appreciate sometimes how much we Know and expect that they are going to understand what we're saying What we need to do to overcome. This is have really clear communication Focus on what they need to know what they need to do be creative Make sure you're using plain language have people review it to make sure you're at a level They recommend basically fifth or sixth grade level to for literacy reasons But for health literacy just keeping it really simple translating materials into different languages when needed and Making sure they have communication methods to reach you know who to contact when they don't understand And I just want to put a plug in there for we give them a lot of information and they're often very anxious So those are some things that we also have to take into account Patient engagement for our team meant we handed them a lot of paperwork This is paperwork. We gave them before surgery and after surgery so that stack may look a little bit Exaggerated, but it's not that far off. Some of our discharge summaries were 50 pages of paper And and we were having patients tell us I really don't want that big stack of paper. Can't you send this to me electronically? And at first we thought well Maybe there's a lot of patients that wouldn't use technology in fact when you look at the statistics less and less people are telling us that they don't have access to the internet and More and more of our patients are going out there on their own Going to dr. Google. We want them to know what we want them to do. Not what everybody else's program is telling them So our first step in improving our engagement was to build a video library We picked the topics that we deemed were the most crucial for them to understand And used our own staff. Patients love seeing somebody they saw in a video before they came to the hospital Explaining things that they need to know we have a pre-op video post-op video and other key things And then once we had these videos and we really streamlined our education We wanted a method to give it to them electronically So we partnered with a company and built a digital platform that's customized with our information During their transitions of care that it's important. So pre-op they're receiving pre-op to do's when they're in the hospital They're receiving information about what they should be doing in the hospital to prepare for discharge and so on and so forth And I'm going to tell you a little bit about how we collect patient reported outcomes using this device So our patients are asked survey questions. So how do we collect patient-reported outcomes using this device? We collect patient-reported outcomes using this device. So our patients are asked survey questions So while they're in the hospital and for 30 days after they leave the hospital those Survey questions have custom answers. So if you write in there, you don't understand your diet We're gonna give you the push the diet to the patient if the patient triggers something that I want to know about that's concerning It's gonna send me an alert. So you see that dashboard? I have an alert that a patient has triggered something that I have deemed should be addressed So, I know what you're thinking Oh my goodness, that app is probably telling them to call your office all the time. That phone is probably ringing non-stop Well, in fact the majority of the patients are receiving self-care tips and they're told this is a self-care tool If we if it tells you to call us 24 7 we have someone at the other end of the phone But we're not sitting there tracking this 24 7 So we make sure we have people that can address that their concerns But the majority of our patients are either all clear self-care Very rare is it that they get the you need to go to the emergency room? I know the other questions. I'm kind of trying to answer them are well Not every patient is going to use this and I think we've come to appreciate that it there's no one-size-fits-all Some patients do still want all that printed material and we give them all that printed material We use tablets in the hospital and play videos for them so they can see those videos And we make the videos also available in other methods. We can email them links, etc, etc But we do try to focus on engaging as many patients with the technology as possible and we survey them about their If they liked it or not, and we have good responses from the patients So our patients overall that are using this technology have had relative reduction in Readmissions and length of stay things that are important to our teams members and also to the Make sure that we have a return on investment that's favorable. So we have seen this over the years The big question for us was oh, is it only your patients that are really healthy that use this and only your young patients? Well, in fact, it is all of our patients Across the board that have used it and we broke it up by their STS risk of mortality score and Yes, we have more that are in the lower risk score but I'm going to show you a slide that shows even when you break out the outcomes by all outcomes say they They do well If they're using the app, they do better than if they're not using the app. So in each risk score We looked at like Readmissions length of stay and we look to see if it was just our patients that were low risk and I hope I'm explaining that so you can see we cohorted each risk score So now I'm going to give you an example of how Collecting these PROs can impact your program as a whole So when we first started using this it was overwhelming the number of patients that were saying they weren't Ambulating in the hospital because there was nobody to help them These are the patients words that I have highlighted here. And when we took this to our leaders How are we going to overcome this? It's it's staffing and It sparked enough concern that we had a walking orderly Position created for our intensive care unit and now our patients in and the all the patients that are in that intensive care unit benefit from this walking orderly that is walking patients all day long So in the future What opportunities are there related to patient reported outcomes? It's determining really what matters most of patients and I won't lie The this our platform is set up with what we thought mattered most perhaps there's things that matter more to them We need to standardize tools. We need to make sure we're standardizing when we're collecting this information But and hopefully someday they'll be will be benchmarking against each other and learning from each other And and publishing on this I think it's an exciting field, you know, we're not just doing surgery, but we're really helping people We're focusing on their functional recovery with which is really what it's all about So in closing, I'd like to just kind of Mentioned that technology is great. We are really enjoying using technology, but at the end of the day, it's really about people It's about patients that are engaged with thirst for knowledge So that they know what they need to do and it's team members that are able to help patients It's not that the tool itself isn't going to solve all the problems of what we have in health care And I thank everybody for taking time to listen to my presentation today

Cheryl Christoffi

coordinator nurse

patient reported outcomes

patient engagement

health literacy challenges