Reverse the Trend in Nursing Turnover
Part 1: Automating Patient Education
Heather Wood, CPXP, VP, Clinical Innovation, eVideon
Before patient experience was a thing, I have been passionate about improving it. As a young energetic patient educator in the 1990’s, I remember spending 70% of my day tracking down patient education content to help patients and their families get the tools they needed to prepare for discharge. That meant finding the TV cart and the correct VCR tape (I just said VCR, didn’t I?!), and/or creating a new patient education handout and moving it through the required approval process. I was proud to serve patients and their families. But the process was slow, and cumbersome for both patients and staff.
I learned early on that to improve the patient’s experience, we had to also improve the nurse’s experience. I think about this a lot today – 30 plus years later – when the need to relieve nurses of administrative burden seems more critical than ever before. Healthcare is in a nursing crisis. According to the 2021 NSI National Health Care Retention & RN Staffing Report, since 2016 the average hospital turned over about 90% of its workforce—an alarming 83% was RN staff! In 2020, the turnover rate for staff RNs was at 18.7%, a 2.8 percentage point increase from 2019. The Covid-19 pandemic has driven many registered nurses out, and the shortage means hospitals are facing between $3.6 - $6.5 million per year in turnover costs.
While bending the cost curve is a business imperative, solving the nursing crisis is the responsibility of all of us in healthcare. The time to act is now and the technology to make an impact is here. To truly support nurses, organizations must adopt innovative technologies that automate clinical workflows, remove repetitive and redundant administrative tasks, and enable nurses to connect at a more personal level with patients.
One such way to achieve this is by improving the deployment and oversight of patient education programs so nurses can devote more time with patients directly to assess and augment their learning. Early in my career, I never imaged that a nurse, within their normal workflow, would be able to assign personalized and focused education based on their patients’ current condition and stage of care, and send that education directly to the in-room TV and/or a personal device. Let’s take a deeper dive into what’s possible.
AUTOMATED ASSIGNMENT & DOCUMENTATION
The Healthcare Education Association’s Patient Education Practice Guidelines state that effective patient education must meet each of the four components of the patient education process: assessment, planning, implementation and evaluation (APIE). The challenge is that nurses do not commonly have the time required to ensure all four stages of the process are met. Leveraging a technology that integrates with the EMR can streamline the assignment and documentation of patient education, placing less of the administrative burden on the nurse.
At eVideon, we align the EMR’s current education-required teaching points and map them to specific education programs. The EMR has the patient’s correct diagnosis (based on ICD-10 codes or DRGs),which permits us to map specific education to that individual’s diagnosis and stage. Always giving nurses and/or educators the ability to edit the education assignment for each patient if necessary. For the nurse, delivering patient education seamlessly, automating documentation of completion, and pushing out comprehension questions for follow-up can all contribute to significant gains in clinical efficiency.
Meeting the patient where they are in the learning process of their condition will not only gain their trust but build a meaningful relationship between patients and providers, cultivating patient loyalty. When educational content is personalized to meet an individual’s unique need, patients are more engaged in their care and more satisfied with their experience.
One way to ensure this is by acknowledging the correct stage of care. For example, if a patient has a history of heart failure and they are recently readmitted due to heart failure, providing educational content on “an introduction to heart failure” may be less than effective in helping them understand their current situation. In this example, the patient may perceive that the care team is uninformed of their medical history and, possibly, even unaware of the reason they have returned to the hospital.
eVideon personalizes the hospital experience upon arrival and enables the nurse to carry that through to education assignment. Here’s a sample education assignment workflow:
- Nurses assign tailored education through the EMR and assignments appear for the patient and/or loved ones via their in-room TV or a personal device. This includes gentle reminders that the education has been assigned specifically for them.
- Completion is automatically documented back in the EMR and content that has not been watched is identified through reporting and follow-up.
- Comprehension questions are used to evaluate the patient’s understanding. When the patient gets an answer incorrect or indicates they have questions, a notice is sent to the nurse requesting follow up.
The educational content is tailored to address literacy challenges, language, and culture needs—videos are short, specific, and updated regularly. The patient education is also consistent, meaning that the healthcare team has selected on the content, and it is not subject to the interpretation of one nurse or one member of the care team. The result: nurses spend more time at the bedside with their patients, working at the top of their license.
While patient education is mandatory, it is critical to ensure that the delivery of the content truly brings value to the individual, or individuals, receiving it. Putting the right information at the right time in front of a patient and/or their loved ones can make a world of difference, and it can have a significant impact on their health outcomes.
At eVideon, we can engage patients via text messaging, on their own device, in their preferred language; and thus, empower them to manage their own health. Patients may have lifestyle changes, multiple instructions for medications and home care. To make it easy and convenient, video education can be paused, rewound, or fast-forwarded. eVideon tracks where the patient left off, provides gentle reminders for completion, and offers post-educational surveys to assess comprehension. We help to provide better transitions of care for patients and their loved ones, and for hospital leaders seeking success in a value-based environment, the effective deployment and oversight of patient education is critical to achieving lower 30-day hospital readmission rates.
In many ways the industry has come so far, and in other ways we have clogged the good intentions with uncoordinated and burdensome tasks for clinicians. Patients and nurses feel all the good and the bad. Bedside care should never be taken over with technology but using the right technology to provide personalized education that is consistent, focused, efficient, and effective can serve as the cornerstone of clinical operations in every hospital today. I'd love to hear your thoughts on this topic, feel free to email me with your ideas and questions!
Stay tuned for my second blog on this topic where I'll discuss how we can further support nurses by automating non-clinical service requests!