Poor patient engagement can have many negative downstream effects for surgical patients when they do not follow their recommended care plans.
At ButlerHealth System in Butler, Penn., we were recently looking for a better way to engage patients who undergo joint replacements at our facility. We adopted a guided patient engagement solution for our joint replacement patients and have realized the benefits of better patient preparation, rapid feedback and staff efficiencies.
BHS is a community health system providing services to patients primarily in the counties just north of Pittsburgh. throughout Western Pennsylvania. The BHS Orthopedic Center is a 24-bed unit within the hospital that specializes in inpatient orthopedic care and physical therapy, and local physicians perform about 500 total joint replacement procedures each year.
As the service line coordinator, I was tasked with starting a dedicated orthopedic service line at BHS in 2008. My first project was streamlining patient care protocols and implementing a successful face-to-face education program for total joint replacement patients, called "Total Joint Camp."
Before instituting the pre-surgery program, patients were arriving poorly prepared to their TJR procedures. Most had elevated anxiety and had not made arrangements for post-discharge care. Additionally, delays in patient information collection reduced staff efficiency across the continuum of care, from discharge planning to functional outcomes measurement.
Looking to further optimize the program, I considered the use of online technology to supplement my program to provide patients and staff with access to information when they needed it. However, many of my peers and staff did not see that as a solution. The common belief was: "Our joint patients are older. They don't use computers."
However, I was still optimistic. Knowing that baby boomers are becoming increasingly computer-savvy, we administered a "Technology Readiness Survey" in the pre-op waiting area and found that 70 percent of Butler's total joint replacement patients were interested in using an online platform to manage their surgery and recovery plans.
BHS' Director of Emerging Technology, Cindy Esser, discovered a company called Wellbe and brought it to me as a possible solution provider. We worked together with the Wellbe team to design a Guided CarePath (an online patient journey) for hip and knee total joint replacements, which we called BHS TotalCare.
Patients can access their Guided CarePath online as soon as they schedule surgery and interaction continues through four months post-surgery, with three-month, six-month, and one-year functional outcomes surveys to collect results.
The Guided CarePath provides actionable surgery education including pre-/rehab exercises and what to expect, along with opportunities to collect information from patients, like home assessments and discharge planning forms.
BHS Orthopedic Center derived numerous benefits from the implementation of its Guided CarePath for TJR patients. It provided consistent patient preparedness and cost savings in the collection of information and feedback from patients:
- Anesthesia found that patients came in more prepared, which led to better and more focused questions and a smoother pre-op process.
- Patients felt more prepared and less surprised because they could easily involve their family members in the interactive program. According to their 2013 Patient Preparedness Survey, 81 percent of patients felt very prepared, 19 percent somewhat prepared, 0 percent somewhat unprepared and 0 percent not prepared.
- Previous paper HCAHPS surveys were delayed and not specific to TJR patients. The Guided CarePath gave the department the ability to immediately respond to orthopedic patient feedback. For example, one patient requested hand sanitizer at the bedside and the change was made quickly.
- The ability to include videos helped with facial recognition of staff members once the patient entered the hospital. Physical therapy exercise videos shortened the first PT encounter and saved time on length of stay.
- Functional outcome results, which are difficult to obtain, but are increasingly required by insurance providers, are now collected without additional staff costs.
The online guided program for total joints has become a wonderful adjunct to our face-to face-teaching. It reinforces the pathway in small doses that do not overwhelm the patient. I'm pleased with the ability to collect real-time data that enables rapid program modification and boosts patient satisfaction. We are ahead of the curve in providing functional outcomes data with minimal staff effort.