Members in Action: Improve Quality & Patient Outcomes Children's Wisconsin – Milwaukee Better Communication with Families Leads to Improved Outcomes for Children The AHA's Members in Action series highlights how hospitals and health systems are implementing new value- based strategies to improve health care affordability. This includes work to redesign the delivery system, manage risk and new payment models, improve quality and outcomes, and implement operational solutions. Overview Impact By expanding communication with patients In 2019, Patient Journey sent out 23,000 messages to and families throughout the continuum of care, 2,400 families. Patient Journey includes 55 care paths Children's Wisconsin is engaging caregivers in for various clinical services. their children's health, thereby reducing visits to A survey of 85 families who used Patient Journey for the emergency department (ED) and decreasing ENT surgery revealed zero post-op ED visits and zero avoidable readmissions. avoidable readmissions. Caregivers also reported Previously, the medical center communicated feeling supported throughout their child's surgery. with families during and immediately following The same survey showed an overall readmission rate their child's surgery. This approach resulted in dropped from 10% to 5%; however, a closer analysis frequent follow-up questions from caregivers identified higher readmission rates for Black and as well as avoidable readmissions. In response, Spanish-speaking patients. To address this disparity, Children's Wisconsin developed a communication Children's Wisconsin translated Patient Journey tool – Patient Journey – to proactively address instructional materials and videos into Spanish, which families' expectations and concerns by providing led to a decrease in readmissions for Spanish-speaking information before, during and after procedures. patients. To address disparities among Black patients, Patient Journey pushes out messages to families Children's Wisconsin is identifying Black children that prior to surgeries, with reminders about pre- were readmitted and calling their families to determine what factors may have led to the readmission. Patient Journey also led to enhanced communication with patients and families, as well as among providers. More timely communication and clarity surrounding pre-operative instructions led to improvements in workflow. The improved communication among providers also yielded a reduction in clinical variation; for instance, clinicians came to a consensus on post- op diet and pain management approaches, including providing Patient Journey instructions for two weeks after surgery on how to safety dispose of narcotic medications. ©2020 American Hospital Association | November 2020 Page 1 | www.aha.org operative instructions, such as food or drink restrictions, as well as what to expect after the procedures. Families also receive instructional videos and supportive text messages following surgeries about the recovery process, hydration, activity, pain management, follow-up appointments and other information to support healing. During the COVID-19 pandemic, Patient Journey has started sending messages with the hospital's safety protocols for masking and visitor restrictions, accompanied by videos of how they are ensuring patient safety at the hospital. Lessons Learned Officials at Children's Wisconsin learned the value of strengthening the connection among primary care physicians and clinical specialists, stressing the importance of continual education and communication to determine the most optimal care paths for the patient. "I think this has been an incredible asset in our tool box," said Cecille Sulman, M.D., chief of pediatric otolaryngology. Future Goals Children's Wisconsin's quality improvement Patient Journey began with the pediatric otorhinolaryngology department in 2014, since expanding to orthopedics and other surgical services. The goal is to integrate Patient Journey throughout the medical center, particularly with primary care physicians and maternal-child health patients. They also are exploring sharing access to the resources with other medical centers that use the same electronic health record platform. Children's Wisconsin also plans to integrate community navigators to engage families, address social determinants of health and reduce clinical disparities. Navigators would connect with patients and families throughout the continuum of care, linking them to resources and providing encouragement along the way. "This has been such a wonderful experience, we're really trying to continue to scale across the enterprise," said Kimberly Cronsell, M.D., medical director for digital health and experience. Contact: Courtney Miles, Senior Project Manager, Digital Health and Experience Telephone: (414) 266-8906 Email: CMiles@chw.org ©2020 American Hospital Association | November 2020 Page 2 | www.aha.org