An overview of the AHRQ Patient Engagement Guide
The Agency for Healthcare Research and Quality (AHRQ) released its patient engagement guide on July 8. The insights contained in the Guide to Patient and Family Engagement in Hospital Safety and Quality were field tested at 3 medium-sized hospitals across the country.
Dr. Carolyn Clancy, from the AHRQ, suggested that the guide is a means of improving communication:
"Many of the errors we see in healthcare stem from communications problems. That's why we developed this resource, to give hospitals practical, evidence-based information to improve communication on the front lines of health care - and ulimately keep patients safer."
The guide offers tools, training materials, and examples for implementing the four strategic pillars that comprise its approach:
I. Working with Patients and Families as Advisors
The goal of this strategy is to bring the perspective of patients and families into the planning, delivery, and evaluation of care. The 59-page guide recommends five steps
1. Identify a staff liaison to prepare staff and clinicians to work with patient and family advisors. This person also recruits, trains, and supports advisors.
2. Identify opportunities for involving patient and family advisors via short term engagements or via an advisory council.
3. Prepare hospital leadership, clinicians, and staff to work with advisors.
4. Recruit, select, and train patient and family advisors.
5. Implement and coordinate advisor activities.
II. Communicating to Improve Quality
The goal of this strategy is to facilitate communication between the patient, family, and clinicians to improve patient safety and care quality. To that end, the guide recommends that hospitals:
"Distribute three tools to the family and the patient upon admission or prior to admission to help them understand the opportunities that exist for engagement, how to be a partner in their care, and the roles of the different members of their health care team. The bedside nurse will review the materials with the patient and family on the first day of admission.
All clinicians reinforce the principles of effective communication throughout the patient’s hospital stay. As hospitals assess the level of staff involvement, they may want to encourage specific engagement from physicians and other staff. For example, when Advocate Trinity Hospital implemented this strategy, the hospital involved not only nurses, but also certified nursing assistants (CNAs) and the unit secretary. Tools are available to help hospitals train, observe, and provide feedback to clinicians on core communication competencies that reinforce the principles of effective partnerships."
Tool 1: Be a Partner in Your Care (Informs patient and family of scheduled opportunities where they can interact with the health care team.)
Tool 2: Tips for Being a Partner in Your Care (Helps the patient and family know how to interact with the health care team.)
Tool 3: Get to Know Your Health Care Team (Help the patient and family understand the roles of different members of the health care team.)
III. Nurse Bedside Shift Report
The goal of this strategy is to help ensure the safe handoff of care between nurses by involving the patient and family. The Nurse Bedside Shift Report includes a checklist of six items required to complete the bedside shift report. Hospitals train nurses on how to conduct bedside shift reports. According to the guide:
"On the day of admission, the bedside nurse or another hospital staff member briefly explains the process, invites the patient and family to be part of the bedside shift report, and gives the brochure on the bedside shift report to the patient.
At each shift change, shift report happens at the patient's bedside, and the nurses invite the patient and family or friends to take part in the report."
IV. IDEAL Discharge Planning
The goal of this strategy is to engage patients and family members in the transition from hospital to home, with the goal of reducing adverse events and preventable readmissions. The IDEAL Discharge Strategy can be used on its own or in conjunction with other initiatives such as RED, the Care Transition Program, and BOOST.
Include the patient and family as full partners in the discharge planning process
Discuss with the patient and family five key areas to prevent problems at home:
1. Describe what life at home will be like
2. Review medications
3. Highlight warning signs and problems
4. Explain test results
5. Make folllow-up appointments
Educate the patient and family in plain language about the patient's condition, the discharge process, and next steps at every opportunity throughout the hospital stay.
Assess how well doctors and nurses explain the diagnosis, condition, and next steps in the patient's care to the patient and family and use teach back.
Listen to and honor the patient and family's goals, preferences, observations, and concerns.
The guide provides a comprehensive framework for improving the experience for both patients and family members during a hospital stay. All in, the guide offers several hundred pages of content, tools, and examples. Hospitals will be well-served to take a look at this guide and leverage many of its resources. That said, the guide falls short of helping hospitals move beyond the encounter-focused view of the world to the most promising area of patient engagement: between encounters.