BRIDGING
PATIENT – CAREGIVER
COMMUNICATION IN THE HOSPITAL
ENVIRONMENT
USING A PERSONAL HANDHELD
WHITEBOARD SYSTEM TO IMPROVE
TEAMWORK, COMMUNICATION, AND
PATIENT CARE
PRESENTATION OBJECTIVES
 THE PROBLEM: PATIENT – CAREGIVER
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COMMUNICATION IN PERSPECTIVE
THE COMMUNICATION PRIORITY
COMMUNICATION RISK FACTORS TO BE
ADDRESSED
EDUCATION AND HEALTHCARE
INDUSTIRES MEET
CHALLENGES TO OVERCOME
IMPLEMENTING PROVEN TOOLS AND
STRATEGIES
HOSPITALS IN THE U.S.
Total Number of All U.S. Registered Hospitals **
5,724
Number of U.S. Community Hospitals**
4,973
Number of Federal Government Hospitals
208
Total Staffed Beds in All U.S. Registered* Hospitals 924,333
Staffed Beds in Community Hospitals
797,403
Total Admissions in All U.S. Registered* Hospitals 36,564,866
Admissions in Community Hospitals
34,843,085
*Registered hospitals are those that meet AHA’s criteria for registration as a hospital facility.
** Community Hospitals are defined as all nonfederal, short-term general and other special hospitals.
THE SIGNIFICANCE OF COMMUNICATION IN
THE HOSPITAL SETTING
Joint commission on Accreditation of Healthcare Organizations
PATIENT VULNERABILITY
 Patients often enter hospital in a “communication vulnerable”
state or become so by virtue of condition or treatment.
 Patients regularly report instances in which communication
barriers result in feeling of anxiety, fear, frustration,
unrecognized pain, and overall loss of control.
 When patient family or advocates are not present, patients are
often left without the tools to communicate resulting in
disorientation and distress.
 Patients with access to communication receive less sedation,
are transitioned faster, have less pain, have increased
satisfaction with their care, feel more in control and generally
do better.
COMMUNICATION PRIORITY
Education and Healthcare Related
 Technology-Related Assistance for Individuals with
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Disabilities Act of 1988, P.L. 100-407
Individuals with Disabilities Education Act (IDEA),
P.L. 105-17
Joint Commission on Accreditation in Healthcare
Organizations (JACHO) 1997 – 2002 Study
JACHO Standard of Care RI.2.100 – “The patient has
a right and need for effective communication”
JACHO National Patient Safety Goals (2007 NPSG –
Goal 13) patients have active involvement in their own
care requiring overcoming communication barriers.
The Affordable Healthcare Act (PPACA)
The Affordable Healthcare Act PPACA
 The Centers for Medicare & Medicaid Services (CMS) will begin the
Readmissions Reduction Program, which requires CMS to
reduce payments to IPPS hospitals with excess readmissions,
effective for discharges beginning on October 1, 2012. The
regulations that implement this provision are in subpart I of 42 CFR
part 412 (§412.150 through §412.154)
 Starting in October, an estimated total of 2,217 hospitals across the
nation will be penalized.
 Together, these 2,217 hospitals will forfeit more than $280 million
in Medicare funds over the next year, i.e., until October 2013, as
Medicare and Medicaid begin a wide-ranging push to start paying
health care providers based on the quality of care they provide.
 Enhancing communication using Patient Whiteboards can reduce
readmissions thereby assuring greater hospital compliance with
PPACA.
Communication Risk Factors
 Effective communication depends on clarity
which is influenced by:
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Culture/Ethnicity
Socioeconomics
Literacy
Gender
Personality/Behavior of Patient
Personality/Behavior of Caregiver
Trauma induced impediment
Overcoming Barriers
 Education Industry and Healthcare Industry share many
of the same Communication Issues.
 Augmentative and Alternative Communication (AAC)
otherwise known as communication tools.
 Two categories of ACC
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Unaided AAC – requires no tools but includes “signing”
Aided ACC – any device, electronic or non-electronic used to
transmit or receive messages.
Low-Tech – Communication aids that do not need batteries,
electricity or electronics. Typically hand-held communication boards
or books depending on physical limitation of users.
 High-Tech – Speech generating devices that permit the storage and
retrieval of electronic messages or voice output communication aids.
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Education Industry Adoption
 The Education Industry has demonstrated positive
experience for students with and without disabilities.
 Education is focusing on Low-Tech for the following
reasons:
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Low Capital Costs – Capital costs are typically orders of
magnitude higher for High-Tech Tools.
Low Maintenance Cost – Low-Tech requires no hardware and
software maintenance and very low expenditures for
replacement of damaged tools.
Low Learning Curve – Most Low-Tech Tools require little to
no user instruction and can be implemented immediately.
Assessment of Skills – Low-Tech enables rapid assessment of
key cognitive and motor skills.
Opportunity For Healthcare
 Communication access in healthcare setting must be
functional, user-friendly, accessible and easy to
acquire as required in the education industry.
 Patient access to tools is critical and can be defined
through assessment and needs analysis of patient,
patient family, and caregiver.
 Tools must be easily and effectively transferrable to
patient home, yet be compatible with hospital
systems.
 Tools must be low cost.
NATIONAL PRIORITY PARTNERSHIP
“THE COMMUNICATION PRIORITY”
 Patient & Family Engagement Convening Meeting
May 2010
 Purpose of Meeting: “to identify actions to drive the
achievement of patient experience of care goal of the
patient and family engagement priority”*
 “NPP selected patient and family engagement as one
of the six priority areas, along with three specific
goals: increasing the use of patient experience of care
measures, improving patient self-management skills,
and increasing the use of shared decision-making
tools.”*
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* Patient & Family Engagement Convening Meeting Synthesis Report May 2010
Barriers to Adoption
 Lack of Administrative Support
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New Requirements for Medicare and other reimbursement
Define as a facility wide initiative
 Lack of Staff Support
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Define as a facility wide rather than department initiative
 Lack of Easy Access within the Healthcare Facility
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Establish procedures
 Lack of Financial Support – Patients may not have
resources to pay for even a $10 item.
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Grant Funding Availability
3rd Party Advertising Funds Available
Incentives to Insurers – Reducing Errors, Reducing Readmissions
Incentives to Hospitals – Reducing Errors, Reducing Readmission,
enhanced patient perspective of care provided.
Patient Whiteboards as a Communication Tool
UCSF 2010 study*
 Education Industry has a proven Whiteboard system and
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Healthcare has demonstrated similar experience.
Personal Patient Whiteboards can serve as a communication
tool between hospital providers and as a mechanism to engage
patients.
Nurses placed greatest value on “Goal for the Day” and
“Anticipated Discharge Date”.
Limited availability of whiteboard markers was considered to
be the greatest barrier to use.
Despite differences in practice patterns between nurses and
physicians all providers valued use to improve teamwork,
communication and patient care.
* Journal of Hospital Medicine Volume 5, No 4, April 2010