Improve Discharge Education On Cardiovascular Unit Using Skilled Communication and True Collaboration

Project Topic:

Improved patient and family discharge education through standardization of post-operative teaching for open-heart cardiovascular surgery patients

Hospital, City and State:

Nebraska Methodist Hospital, Omaha, Nebraska

Unit:

• Cardiovascular Surgery Unit, 9 North

CSI Participants:

• Tim Hoarty, MSN, RN, CCRN-CSC
• Jacee Roseberry, MSN, RN
• Coach: Ellie Rubenfeld, MSN, RN, CCRN

Project Goals/Objectives:

1. Improve patient and family education through standardized RN discharge teaching to >90% confidence in assessed topics
2. Increase patient and family satisfaction with discharge education on Press Ganey to >90th percentile
3. Increase RN confidence and consistency in discharge education process to >90%
4. Increase Healthy Work Environment Assessment Tool (HWEAT) scores on Skilled Communication and True Collaboration to 4.50
5. Decrease open heart length of stay (LOS) and readmissions by 10%
6. Decrease Oldenburg Burnout Inventory (OLBI) scores – specifically, staff reporting disengagement or exhaustion to overall score of < />

Project Outcomes:

1. Goal of 90% “very confident” on patient/family survey – not met. Of the five questions, percentages ranged from a low of 65% with medication education to 87% for overall teaching experience. Overall, the scores from pre- and postimplementation were very similar.
2. See above. We did see high scores on pertinent HCAHPS questions from Press Ganey surveys – however these are for all patients on 9N and not necessarily specific to our post-operative open heart population. These ranged from 86th – 95th percentile, other than medication education/side effects.
3. RN confidence and consistency – partially met. We saw dramatically improved scores on all survey questions and the overall “adequacy of resources” increased from 74% to 91%.
4. HWEAT scores – not met. However, the score for Skilled Communication remained the exact same at 4.19, while True Collaboration increased from 4.06 to 4.12.
5. Decreased LOS by 10% - partially met. CABG LOS decreased by 11%, while valve LOS decreased by 2.6%. Readmissions decreased from 17 to 16 (CABG decreased from 14 to five, while valve increased from three to 11). Ultimately, our team decided that our project likely has little impact on readmissions.
6. Decreased OLBI – not met. Our overall score increased from 35.79 to 37.
7. Potential annualized fiscal savings: $271,129

Project Overview:

0n 9 North, caring for patients who've had open heart surgery is the unit’s bread and butter. Considering how much information the patient and family receive in the midst of their recovery, they can be very overwhelmed. The team felt that a consistent, standardized approach to discharge education that includes families as partners in the process would be a significant improvement for our unit. The project intended to improve the day-to-day nurse education targeted to open heart patients, increase patient and family satisfaction with the discharge education process, and ensure that patients and families are confident in the continuation of their recovery as they head out the front doors of NMH. The team even noted that our project and intervention has made an impact on length of stay and readmission rates, and this as win-win-win!

The team gathered a sample of post-operative open-heart patients and surveyed them prior to kickoff, as well as separately surveyed our nurses to establish baseline levels of confidence, perceptions of consistency and standardization, and to explore barriers. A multidisciplinary approach was used to develop standardized materials that nurses would use to educate patients and families on several different topic areas such as medications, signs and symptoms to report, incisional care and more. This was intended to improve the experience for patients, families and nurses, and also to decrease length of stay and readmission rates for this population. The team was largely successful with a significant 11% decrease in length of stay for CABG patients. While specific goals were not met in every case, positive trends resulted in almost all metrics.

The feedback for the project has been overwhelmingly positive from nurses, patients and families. The team hopes that this project will continue to improve care on the unit and that this model could easily be adapted to other patient populations in the health system.