Published in the December 2009 issue of Today’s Hospitalist
IT BEGAN AS A CHILD’S SIMPLE REQUEST. More than three years ago, a young patient at Golisano Children’s Hospital in Rochester, N.Y., asked for Internet access in her room. The hospital responded by looking into Web options that could link into its own system.
In 2007, an interactive system marketed and installed by GetWellNetwork became a permanent fixture in the hospital’s 85 rooms, which are part of the University of Rochester Medical Center. What started with movies-on-demand, video games and Internet access has now evolved into a patient education system that helps hospitalists relay health care information more consistently and efficiently than before, through a television screen in each patient’s room.
The physicians say the system is still expanding. "We are only beginning to realize the potential of this technology," says Michael S. Leonard, MD, MS, a pediatric hospitalist and chief quality and safety officer for children’s services at the hospital. Dr. Leonard works with two committees that meet each month to review processes and brainstorm new ways to use the interactive tool. "Having a malleable system that can be continuously revised and augmented is a real asset," he says.
Allowing patients to ask questions
Most recently, the hospital began using the technology to educate patients and parents about asthma, one of the hospital’s most common diagnoses. Videos include information on what asthma is, an overview of its symptoms, and information on medications used to treat it.
The videos are displayed on television screens over the hospital beds and linked to a wireless keyboard with a built-in mouse. Parents can watch the videos as many times as they like.
All families admitted to the children’s hospital are shown patient safety videos including reminders about hand hygiene and the importance of reviewing all home medications with the health care team. Other topic-specific videos are "prescribed" by physicians as appropriate and target conditions like influenza and diabetes, procedures such as tonsillectomy and getting an MRI, and Broviac catheter care.
The hospital also uses the system to provide a mechanism for feedback about the family’s hospital experience and to ask questions so that issues can be addressed in real time. Because the physicians participate in multidisciplinary family-centered rounding, patients and families often have large groups of providers in their room at one time.
"Parents are sometimes reluctant to voice their concerns face to face, but may feel more comfortable typing them as an electronic message," says Dr. Leonard.
A way to standardize information
While kids love the entertainment options, parents appreciate being able to review the material as many times as they want, according to Dr. Leonard.
"The first day in the hospital can be overwhelming for families," he points out. "Parents receive a great deal of information from many health care professionals, and the videos allow them to revisit that information at their convenience."
The hospitalists use computerized order entry to "prescribe" asthma education videos that have to be viewed before discharge. Doctors can track what videos families have watched and how often they have watched them.
"We can give families gentle reminders if they are getting close to discharge and have not yet completed their prescribed education," Dr. Leonard said. In addition to required videos, patients and families can scroll through a library that includes videos on other health care topics, such as migraines and eczema, and watch videos of interest to them. "We try to provide access to a wide range of information."
For hospitalists, one big benefit of the system is knowing that all the patients are receiving accurate, standardized information in an understandable format.
"The system’s educational content ensures that families receive consistent, non-conflicting messages," Dr. Leonard says. That also, he notes, reduces the risk of medical errors, which are often the result of miscommunication.
More informed patients
The GetWellNetwork technology also takes some pressure off hospitalists to provide extensive education during rounds. "We can now ask families, ‘Do you have any questions?’ and focus on specific content areas of education," Dr. Leonard says. "It makes rounds far more efficient and effective."
Concerns that the system would replace doctors’ own bedside discussions were unwarranted, he adds.
"GetWellNetwork actually facilitates bedside discussions," says Dr. Leonard. "Families may not be truly hearing and remembering everything a team of providers discusses during family-centered rounds." After families have reviewed the material on the system, hospitalists can focus on what parents don’t understand or those areas they want to discuss more in-depth.
Initial feedback from families indicates that the technology makes them feel better informed and more connected. Though the hospital has not yet compiled its pilot data, Dr. Leonard says his team believes the initiative will also lead to better clinical outcomes, such as a decrease in preventable ED visits and hospital admissions.
Reducing readmissions
Dr. Leonard works with GetWellNetwork interdisciplinary committees that meet regularly and include residents, nurses, hospitalists, quality improvement staff, child-life workers and medical librarians. A company representative is also on-site full-time troubleshooting, correcting problems and helping the committee decide which initiatives to implement next. Routine issues include technological glitches and helping families navigate the system.
Dr. Leonard admits that "any major capital investment like this is always a difficult sell." But "buy-in was relatively easy with our administration because the benefits and potential were apparent," he points out. By providing thorough, standardized education, "we hope that our families will be better able to manage their child’s illness and decrease the number of times patients need to come back to the emergency room or be admitted."
Ingrid Palmer is a freelance health care writer based in West Chester, Ohio.
