Abstract TP465: Improved 30 Day Readmission Rates in the Acute Stroke Population Through Patient Teach Back

Abstract

Background: Our comprehensive stroke center focused on decreasing hospital readmissions and improving patient experience. In 2015, our stroke program had a CMS readmission rate of 9.0%, which was the highest amongst the metro stroke programs in a 12-hospital system. Method: In evaluating the opportunities to reduce hospital readmissions, patient education and patients’ ability to understand discharge instructions were identified as a gap. To improve patient education the stroke coordinator collaborated with the neurology unit nurse manager and CNS to develop teach back education. The team determined that the teach back method would be the primary technique used for stroke education for patients and caregivers. Floor nurses with the responsibility of completing stroke education were trained in the teach back method of instruction. The training was presented at staff meetings and new nurse orientation and reinforced in newsletters and nursing communications. Teach back was reinforced by the stroke nurse clinician who checked in daily with floor nurses to review patient education and plan of care. Further interventions to reinforce patient comprehension included the creation and use of tools and references such as stroke care maps, magnets, posters, and booklets sent home with patients. The stroke nurse clinician who performed seven day post-discharge follow up phone calls used consistent technique during telephone encounters. Additionally, a stroke nurse clinician conducted follow-up calls at 30 and 90 days with teach back strategies imbedded in the phone call script. Results: The consistency of the education and workflow led to improved outcomes in 30 day readmissions. From the 9.0% in 2015, the readmission rate decreased to 5.8% in 2017. The other metric used to measure progress was HCAHPS overall patient satisfaction scores in neurology patients, which improved from 62.1% top box in 2015 to 71.7% in 2017. These results were shared with the stroke providers monthly. Conclusion: Implementation of patient education using teach back was associated with a decrease in hospital readmissions and improved patient satisfaction in the stroke population. Future plans are to expand the use of the teach back method to the stroke provider team.