A sking “teachback” questions to hospitalized chronic heart failure (CHF) patients at Lehigh Valley Health Network in Allentown, Pa., helps them better understand their condition, treatment, and post-discharge care—thereby impacting readmissions. In an abstract presented at HM11 in Dallas in May, CHF patients who received teachback had a 7.3% readmission rate in the first three months of 2011, compared with 9.7% for those who did not.
Teachback, according to hospitalist and lead author Michael Pistoria, DO, FACP, SFHM, represents “humble inquiry—the simple need and ability to ask patients: ‘Can you tell me what I said to you?’” The provider then needs to listen to the reply and confirm the understanding, he adds.
Lehigh Valley convened a multidisciplinary quality team to study transitions of care, with a subgroup focused on patient-caregiver education, Dr. Pistoria explains. “The first thing the patient-family caregiver education team looked at was how to identify the key learner,” he says. “We had assumed it was the patient, but that’s not always the person who needs to learn about managing the patient’s condition.”
The subgroup then developed a curriculum of questions to be asked sequentially over three days to test patients and their caregivers’ understanding of heart failure and need for reinforcement. These questions, drawing upon educational resources already used within the system, assess the key learner’s knowledge, attitudes about healthy behaviors, and how to incorporate those behaviors into effective self-care.
The teachback system was tested on a few patients, then disseminated to 1,400 nurses through Lehigh Valley’s professional e-learning network using a brief training video. “We learned that doing a good job of staff teaching is not enough, unless we go back and periodically revisit the issues and audit their performance,” Dr. Pistoria says. “In our system, starting with our nurses was the right approach. It’s important for everybody to take ownership of the initiative. It’s also important, from unit to unit, to ask the questions the same way.”
Subsequent analysis shows continued reductions in readmissions, Dr. Pistoria says. Lehigh Valley’s next targets for teachback are community-acquired pneumonia, myocardial infarction, hypoglycemia, COPD, and anti-coagulant treatment.