Executive Summary
When Oregon Health & Science University Hospital began video handoffs when patients were being discharged to a skilled nursing facility, readmission rates dropped.
- The hospital nurse goes to the bedside and connects with the nurse who will be caring for the patient at the receiving facility.
- The program makes patients feel more comfortable about the new facility and gives the nurse a chance to meet his or her patient.
- The hospital also conducts educational sessions via video conferencing for the staff at the skilled nursing facilities.
The readmission rate for patients being discharged from Oregon Health & Science University Hospital to a skilled nursing facility have dropped from 26% to 12% among patients whose handoffs were handled via video conferencing.
Using secure, HIPAA-compliant video conferencing, the hospital nurse goes to the patient’s bedside and connects with the nurse who will be caring for the patient at the receiving facility.
The health system started doing video handoffs in 2012 with one skilled nursing facility that was willing to invest in the needed technology and agreed to partner with Oregon Health as part of a larger package to improve the quality of care. So far, the inpatient team has conducted more than 300 video handoffs and now is working with five skilled nursing facilities and Oregon’s only long-term acute care hospital with three more sites scheduled to participate, says Nancy Trumbo, MN, RN, NE-BC, director of care management for Oregon Health & Science University Hospital, located in Portland.
The 534-bed hospital is the only academic medical center in Oregon and 60% of its patients come from outside a 50-mile radius of Portland.
“Before we started this initiative, we had implemented programs to reduce readmissions for patients who are transitioning from the hospital to home. As the health system became more accountable for ensuring that our patients continue to progress once they leave the hospital, we knew we had to partner differently with the post-acute providers,” Trumbo says.
The care management team already had a partnership with skilled nursing facilities and the long-term acute care hospital to collaborate on the quality of care and looked at ways to reduce those readmissions from those facilities, Trumbo says.
“When we researched the literature and conducted a root cause analysis, we found that readmissions for patients from a skilled nursing facility seem to be for a different reason than readmissions for patients who were discharged to home,” Trumbo says.
The team drilled down on readmissions from skilled nursing facilities and determined that patient anxiety within the first 24 hours was one of the major drivers of readmissions.
“Patients weren’t necessarily coming back because of a decline in medical status. They were coming back because they were dissatisfied with the skilled nursing facility, or that their pain was not controlled. We sensed that the root cause of many readmissions was anxiety related,” she says.
The care management team began looking at ways to make patients feel more comfortable about the facility where they were going, Trumbo says.
Oregon Health & Science University already had a robust telemedicine program it rolled out in 2007 to provide support for clinicians treating pediatric patients in outlying hospitals. The telemedicine network has been expanded to hospitals and outpatient clinics across Oregon and provides diagnostic and treatment advice on a wide range of diagnoses, says Jean McCormick, RN, MSN, clinical nurse educator for telehealth services.
“We are always talking about different ways to use telehealth services. Teleconferencing offers a creative way of making handoff reports. It enhances the process because nurses at the receiving facility don’t get a full picture of the patient when the hospital nurse just talks to them,” McCormick says.
The care management team and the telemedicine team collaborated on the development of the program and continue to work closely, Trumbo says.
“There is no way we could do the work we do without a partnership with telemedicine,” she adds.
When patients are ready for discharge, the case manager contacts the receiving facility and arranges for the videoconference between the hospital nurse and the nurse at the receiving facility. The goal is to have the videoconference 15 minutes before the patient leaves the hospital, McCormick says.
A case management assistant connects with the receiving facility and hands the tablet to the nurse. “We did not want technology to be a barrier that made the bedside nurses reluctant to conduct a handoff report over a tablet at the bedside instead of the telephone, so we have our administrative coordinator take care of the technological details,” Trumbo says.
The program has grown so much that the care management department no longer has enough personnel to handle setting up the video conferences for the nurses on the 16 units. The unit secretaries are being trained to make the video connection, Trumbo says.
In the past, the nurses made the handoff call from their desks. Now that they’re in the patient rooms, the nurse at the receiving facility can see the patient and any equipment being used, McCormick says. “Patients have an opportunity to speak about their care and most of them do. It makes them feel like they are a part of the plan,” she says.
Being a part of the videoconference helps allay the anxiety patients may have about going to a new facility where they don’t know anyone, Trumbo says.
“Often, patients are apprehensive about going to a skilled nursing facility but they have been delighted to be involved in the video handoff. They get to meet the nurse who will care for them in the new facility and this makes them feel much more comfortable about going. They know they will see a friendly face when they get there,” Trumbo says.
Some staff were reluctant to try the technology at first, Trumbo says. “It’s easy for the younger nurses who are accustomed to an online presence, but some of the other nurses are less comfortable with the technology but they see the benefits,” she says.
The unit nurses appreciate the ability to have face-to-face conversations with the nurse who will care for the patients and have begun to develop relationships with them. The skilled nursing facility nurses like being able to see the patients and start the relationships, she says.
Once the facilities invest in the teleconferencing technology, they can connect with anyone on the network, Trumbo says. For instance, when the LTACH discharges patients to a skilled nursing facility, the staff conducts a warm video handoff.
The next phase is to develop the ability for the nurses and physicians in the hospital emergency room to examine skilled nursing facility patients via teleconferencing when the nursing home staff is concerned about their conditions, potentially avoiding an emergency department visit or a hospital admission.
“Now that CMS has begun a readmission reduction program for skilled nursing facilities, they are willing to pay the hospital for a remote physician visit. It can avoid a readmission, decrease our emergency department utilization, as well as decreasing adverse effects on patients. It’s a way for us to make sure patients get the care they need at the bedside,” Trumbo says.
The readmission rate for patients being discharged from Oregon Health & Science University Hospital to a skilled nursing facility have dropped from 26% to 12% among patients whose handoffs were handled via videoconferencing.
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