Video details the process for discharge planning
Works for patient, staff education
A video explaining the discharge planning process and its players is finding a rapt audience among patients and their families. It also is being used as a training tool for staff handling discharge duties at small hospitals.
Discharge Planning, released in December 1994 by the Missouri Patient Care Review Foundation in conjunction with its educational affiliate, Comquest, was produced in response to a need identified in the organization's medical review process and through calls to its consumer hotline, says Carol Beahan, communications/education specialist for the Jefferson City-based foundation, which is the Medicare peer review organization (PRO) for Missouri. She sees no reason why other state organizations or larger health systems could not put together a similar production.
Two issues led to the video's development. First, when patients called the PRO to question notices of non-coverage, they often indicated that they didn't understand why a social worker had visited them in the hospital, says Cathy Athon, director of communications/education for the foundation.
In addition, the foundation's retrospective review of the inpatient medical records process identified some cases of incomplete discharge planning, Beahan adds.
To address those two issues, the foundation's outreach committee recommended that it develop a video to educate patients on the discharge planning process. Some studies have shown that older people recall information better when it is presented in a video rather than in writing, Athon says.
"We realized that patients didn't know what was available, and didn't have the tools to ask," Beahan says.
Patients and families are asked to make decisions quickly about care after discharge and have to rely on health care providers, whom they often see as adversaries, for help, Beahan says. "We wanted to help people understand why discharge planning is important, so they can work with providers, knowing what questions to ask and how to access that part of the health care system better," she says.
The foundation identified five objectives for the video:
* to provide an explanation for the following questions: What is discharge planning? Who should have a discharge plan? What are the components of a good discharge plan?
* to provide information on questions that could be asked on an assessment by a discharge planner;
* to provide information on services that could be coordinated for a family;
* to illustrate the overall benefits of discharge planning;
* to explain what Medicare beneficiaries or their representatives can do if they disagree with the discharge (hospital issued notices of non-coverage).
"We want people to realize that they can disagree," Beahan says.
Medicare beneficiaries -- including seniors and the disabled, and their families or representatives -- are the primary target audience for the video, she says. The ideal scenario is that it would be shown several times a day on patient access television channels in the hospital room, so that either the patient or family would know who to contact with any questions about the discharge process, Athon says.
Social workers, discharge planners, social service agencies, and ombudsmen are the secondary audience for the video.
Athon says the department will do one thing differently the next time it produces a video, or any another vehicle aimed at getting across a particular message: Have a plan for measuring results.
"The lesson we learned is that in any future intervention, we will make decisions up front on how to evaluate its effectiveness," she says. "We will do a pre-test and post-test to determine patients' knowledge before and after, and test to see if it prompted any change."
In this case, the foundation produced the video and offered it to hospitals to use in promoting education and awareness, but did not require a commitment from them either on using it or on measuring results.
Development of the video slightly predated a new push by the Washington, DC-based Health Care Financing Administration on measuring the results of communication strategies, Athon says. However, a clinical study now under way at the foundation offers the opportunity to obtain some concrete measurements on the video's effectiveness, she says.
The video will be used in conjunction with a discharge planning study of patients with the diagnosis of congestive heart failure, Athon says. That study will explore ways to reduce readmissions for the condition. Nineteen hospitals in southeast Missouri have been asked to participate, and those who join in the effort will be asked to include the video in the patient-education part of the study, and as part of internal education for the nursing staff, she says.
Athon says she and her staff have found that the discharge planning video -- designed to promote patient awareness -- also is being used by some hospitals in staff meetings and for training of new employees.
Although it wasn't something she expected, Athon says she is pleased that the video is serving a dual function.
"At many rural hospitals, there are not a lot of MSWs doing discharge planning," she says. "In many cases, [discharge planning] is being done by floor nurses coming right out of school. Hospitals see [the video] as a method of getting the staff familiar with the process."
[Editor's note: Discharge planners who would like a free copy of the video may write the Missouri Patient Care Review Foundation, 505 Hobbs Road, Suite 100, Jefferson City, MO 65109. Telephone: (800) 735-6776 or (314) 893-7900.] *
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