Healthcare: The Changing Face of Quality
Diane M. Goodman, APRN, BC, CCRN, CNRN, is in staff development at Advocate Condell Medical Center, Libertyville, IL.
Quality used to be an easier concept to define for nurses and healthcare providers. If the patient recovered during their length of stay and avoided the quagmire of hospital-acquired assaults such as pneumonia, urinary tract infections, skin breakdown, etc., the provider could be reasonably assured appropriate care had been provided. Now, however, providers must also predict the future, by taking educated guesses at exactly when the patient may become ill, and praying the episode doesn't occur within the next 30 days.
Discharge teaching has never been more important. Any tools the patient can be taught for follow-up care, self-care and disease management become vital once the patient is in the home environment. Do they understand how and when to take new medications? Do they know when/how to obtain refills of medications, or which specialist to call for new and/or unusual symptoms? Discharge phone calls provide reinforcement to both the patient and family, but is one post-discharge call enough?
Understanding how the patient learns new information and, what if any tools they have in the home, becomes pivotal to keeping the patient healthy, and may be the new definition of quality healthcare. Does the patient own a smartphone, computer tablet or Web-based TV? Adding an app to track daily symptoms may help the patient understand the connection between increased salt intake, elevated blood pressure and episodic shortness of breath more easily than stepping on the scale and monitoring for weight gain.
Do they belong to a support group? People who have survived stroke, individuals with diabetes and patients suffering from fibromyalgia have gained significant pointers via communal sharing and coaching. Do they live alone, but are somewhat borderline for independence? New technology has provided us with tools that utilize "motion sensors" to determine when/if a patient falls, unlike previous models that required the patient to "push a button" to summon help.
What used to be "quality" in healthcare is no longer enough. One has to be able to anticipate future needs of patients when they are discharged and look far beyond statistics such as LOS and patient satisfaction. One needs to remain tech-savvy, well-read and on the cutting-edge of resource management to keep patients stable once they have left the safety and security of the acute care facility.