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June 26, 2014

Patient-based Healthcare

Scott Stockdale

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Healthcare professionals from St. Mary's General Hospital, the St. Joseph's Health System, and the Waterloo-Wellington Community Care Access Centre want the community to know that they are using a system that puts the patient journey at its core.

The pursuit of a more integrated healthcare system, which can better manage the transitions between hospital and the community, was the focus of healthcare professionals from St. Mary's General Hospital, the St. Joseph's Health System, and the Waterloo-Wellington Community Care Access Centre, at the John Sweeney Lecture in Current Issues in Healthcare, at St. Mary's General Hospital, in Kitchener recently. The lecture was sponsored by St. Jerome's University, in partnership with St. Mary's General Hospital.

As a result of consultations with patients, these healthcare professionals have determined that the transitions between hospital and the community is an aspect of our healthcare system which patients often find frustrating, confusing and expensive.

Sandra Hett, Vice President of Services and Chief Nursing Executive, at St. Mary's Hospital, told the audience that healthcare professionals around the world are facing similar challenges.

“The population is aging and providers are aging. The average age of our nurses is 48. The complexity of care means we need multiple specialists. We have rising costs and shrinking budgets so we must have greater value for our care time.”

She added that this involves shifting the focus from acute operations to building relationships between patients and healthcare providers.

Elizabeth Kingcott, Clinical Educator for Medicine and Surgery Programs at St. Mary's Hospital, said most of healthcare is self-care, so the hospital healthcare professionals try to teach patients how to look after themselves after they leave the hospital.

“With patient education they are less likely to come back to the hospital in 30 days. We're training nurses to do patient education at the right time.”

She explained that it's not enough for nurses to give patients information: they need to relate the information to the individual patient's life, so the patient can look after himself or herself at home. She listed the four steps healthcare professionals teach patients, which not only helps them look after themselves, but helps build trusting relationships with their health care professionals.

i) What do I do if my symptoms return?

ii) What other things can I do to stay healthy?

iii) What medications am I taking now?

iv) Is there someone I can call for help?

Considering that many people, especially the elderly, don't understand complex medical jargon, health literacy is also an important aspect in educating patients, Ms. Kingcott said.

“It can be life-threatening if patients don't understand instructions.”

In order to help patients understand instructions, Ms. Kingcott said the healthcare professionals give them bit-sized pieces of information and they try to do it in conversation to simplify the complexity of the care they are receiving. Moreover, the healthcare professionals try to get some feedback from the patients themselves.

“We interview patients on the floor to see how well we're doing in meeting their needs.”

They also give patients a Patient Discharge Sheet which includes things such as danger signals, when to resume normal activity, side effect of medications and, depending on their symptoms, and who to call if they need help.

Meanwhile, in an effort to provide continuity of care and information, one healthcare provider is assigned to the patient to coordinate information  and care and provide information in a timely fashion, as the patient moves from one part of the system to another.

Donna Johnson, manager of St. Joseph's Healthcare in Hamilton, said healthcare providers communicate with each other and they bring healthcare providers into the home, if needed, so they are hospitalized less.

“If the patient doesn't feel good, we tell them to call their nurse.”

LeeAnn Murray, project lead for integrated comprehensive care program at St. Mary's Hospital said a care package for each patient includes a shared electronic health card, which can assist the healthcare professionals in triggering expert intervention.

“This may be a nutritionist, or a respiratory provider, for example. Patients can call a 1-800 number and access one of our team. Every member of the team has the information on what the patient's profile was in the morning. We also do weekly rounds where the entire team talks about a patient: what should we be focusing on?”

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