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Someone On the Outside (SOS): Help for Recently Discharged
Cardiology Patients B6 | Care from a Distance
A Kaan RN MCN, H Andrews RN, C Bancroft RN BSN, C Boyce RN BSN
St Paul’s Hospital, Vancouver
Disclosures
• A Kaan
– Research Grant Involvement • HeartWare Inc
– Clinical Trial Involvement • HeartWare Inc
– Honoraria • Novartis, Servier and HeartWare Inc.
• H Andrews, C Bancroft, C Boyce
– No disclosures
Aim
• To test the feasibility of a “help-line” that patients could call after discharge from the cardiology ward.
Background
• Complex patients at discharge
– Transition teams
– Follow up calls to high risk patients
• Volume of information at discharge
– Disease information
– Medications
– Follow up instructions
Assumptions
• For most “routine” patients, there is a vacuum of healthcare support until GP follow up at ~2 weeks post discharge
• Some readmissions may be avoidable if the patient/family could get quick advice from someone who knows them
Testing these assumptions
• Installation of SOS Help Line
– Unit based
– Checked daily (M-F) by Clinical Nurse Leader
• Knows patients
• Quick access to MRP and chart
– Poster and handout to patients at discharge
– Opened Oct 2014
Overview
Mean Min Max
Age (years) 66 32 92
Duration of call (min)
7.5 0 15
Total time taken (min)
9 1 35
Days from d/c to call
5 (median) 0 >365
• 64 calls from 46 patients over 16 months
Calls over time
0
2
4
6
8
10
12
O14
N D J 15
F M A M J J A S O N D J 16
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
#
4 calls
3 calls
2 calls
1 call
Repeat calls
33
9
3
1
Nature of Calls (n=64)
Admissions potentially averted (n=64)
8
56
Discussion • Average 4 calls received/month at 7-10 minutes duration
• Mostly issues re – Information
– Medications
– follow-up
• 30% patients call more than once
• Not only complex elderly patients/families confused – No difference between age groups (> vs. <65yr)
• # of calls
• Types of calls
• Averted admissions
• 27/28 pts expressed satisfaction (unprompted)
A story
• 42 year old patient with newly diagnosed HF
• Wife anxious +++ - called to say severe hypotension (90/50)
• On questioning, pt stated he felt fine
• MRP called
– RN able to provide reassurance that this was expected and reviewed HF information
Another…
• 66 year old male pt
– Rx at discharge contains different meds to previous list
– New meds too expensive – pt can’t afford
– MRP contacted
• New Rx faxed to pharmacy with more affordable meds (same as before)
– Med rec performed and pt stated he was extremely satisfied
What are we most proud of/what is the single biggest change that has taken place?
• Proud
– Simple and cost-effective way to help patients find answers without being given the “run around”
• Change
– Bedside staff now have clear message about how hard it is for people to remember all instructions
What was our single most significant lesson learned?
• Of over 2,000 discharges over 16 months, only 64 calls received (3%)
– Fears of overutilization allayed
• Pts who call more than 2 weeks after discharge, or patients who call frequently (>twice)
– May pose a challenge for units who have many patients with no GP
Conclusion
• The SOS line is feasible and provides cardiology patients with a simple option to seek help from a recently encountered care provider.
Contact Information
• Annemarie Kaan – Clinical Nurse Specialist
• Holly Andrews – Clinical Nurse Leader
• Carrie Bancroft – Clinical Nurse Leader
• Candace Boyce – Registered Nurse
