Background and Problem Statement:
Chronic medical conditions are a significant problem in health care. Chronic conditions affect 60% percent of the nation’s population and account for 90% of healthcare dollars spent (Irving, 2017). Baby boomers accounted for one quarter of the population in 2012 and by 2029 it is expected that over 71.4 million people in the United States will be over the age 65, up 14% from 2012 (Pollard, & Scommegna, 2014). As baby boomers age and become a larger portion of the population, it is expected that the rate of chronic conditions will increase. The emergence of pay for performance measures has placed increased focus on care transitions and emphasizes effectively treating patients to adhere to clinical guidelines at home. Patient education enhancement is paramount as organizations work to reduce performance penalties by improving quality and patient care experience. As the volume of patients with chronic conditions increases, the current model of disease specific education coordinators or nurse navigators may not be sustainable. Education needs to be interdisciplinary and occur across the healthcare system to enable patients to effectively care for themselves at home (Marcus, 2014).
This investigator recognizes there is variation in education approaches across nursing units, team members and organizations. Education has shown to be the key to improving patient outcomes. Organizations and health care leaders have a responsibility to ensure the health care team members have adequate skills to educate patients and ensure that quality care is achieved and maintained. Nurses are responsible to ensure educational interventions are provided in an effective manner to patients. One evidenced-based nursing educational intervention is teach-back. Teach-back is the process of providing education in a way that the learner understands and then asking the learner to relay back to the teacher what they understood. Teach-back has been an evidence-based education tactic used in relaying healthcare information and research demonstrates that it is effective in improving patient literacy and adherence (Ha Dinh, Bonner, Clark, Ramsbotham, & Hines, 2016).
Purpose: To evaluate the effects of a teach-back toolkit intervention on readmissions over 30 days among adult neurological patients. Secondarily, the project assessed the impact of a teach-back toolkit intervention on nurse perceptions of conviction and confidence.
Methods: This project used a quasi-experimental design comparing two acute care inpatient units. Both units treat patients with a primary neurological diagnosis. One unit included neurovascular patients and the other treated primarily epilepsy patients. These units were chosen because they had similar diagnosis, bed size, acuity levels, length of stay and staffing ratios. The units range from 12 to 17 beds with and average daily census (ADC) of 10-15 patients per unit.
Participants on the neurovascular unit were placed in the teach-back intervention group and participants on the epilepsy unit were placed in the standard care control group. A quasi-experimental design was chosen over a randomized control trial because it was not feasible to complete the monitoring of patients required in a randomized trial over the allocated implementation time. Nursing team members on the intervention unit, were trained on teach-back utilizing the Agency for Healthcare Research and Quality (AHRQ) sponsored Always Use Teach-Back Tool Kit (Abrams, M.A., Rita, S., Kurtz-Rossi, S., & Neilsen, G, 2012). This tool kit consists of a description of the 10 competency elements associated with teach-back, an interactive learning video, a conviction and confidence assessment tool, and an observation assessment tool.
The nurses on the intervention unit completed a Conviction and Confidence perception survey about teach-back pre-and-post intervention and attended an interactive educational session prior to implementation. Teach-back was implemented, and pre-post data was analyzed utilizing descriptive statistics, Chi Square, and Mann Whitney U tests.
Results: Thirty-day readmission rates reduced from 12.2% to 9.41% on the intervention unit and 12.2 to 10.66% on the control unit post implementation. There is no significant difference in readmission rates (p = 0.1335) between intervention and control units. Nurses conviction post- test scores regarding teach-back was not significantly different from the baseline (p = .0625). A significant difference between pre and post nurse confidence scores was demonstrated (p = .014).
Conclusions: Results did not show a significant difference in 30-day readmission rates. The project had limitations in the study design and may impact the study outcomes. Nurses had a high perception of importance prior to the implementation and it isn’t known how much teach-back was utilized in practice prior to implementation. A longer follow-up study with a stronger design is needed to calculate the effectiveness of teach-back implementation.
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