CodeH(elp): Patient and Family Experience with a Patient and Family Activated Response System

Abstract

Introduction

Under the Strategic Direction the Care Experience Providence Health Care (PHC) has committed that “We will have person and family centred care as our approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among healthcare providers, the people we serve and their families.” (Providence Health Care, 2015). One initiative PHC piloted and implemented under that Care Experience is a patient and family activated response system called CodeH(elp). Piloted in March 2013 on two medical units and later spread and implemented to a total of five medical units in an acute care tertiary hospital CodeH is currently expanding to four surgical units.

CodeH provides patients and families 24/7 access to a Clinical Resource Nurse should they have concerns which they feel they have been unable to address with their care team. The Clinical Resource Nurse attends the bedside, works with the patient or family who placed the call and then engages with members of the healthcare team to resolve the patient’s concerns. The Clinical Resource Nurses report through the Professional Practice Office, and are therefore not part of the local team caring for the patient and family, which allows them to be third party to the presented concerns. They are experienced nurses with Critical Care or Emergency background and skilled communicators.

Code Help was implemented to provide an additional source of support and safety for patients and families.  Code Help enables patients and families to act as partners with the healthcare team for quality and safety and supports person and family centred care.

The steering committee included two patient partners who collaborated on the planning, design, implementation, spread, and sustainment of  CodeH. Implementation included tent cards at each bedside with CodeH information as well as posters in each patient room.  When CodeH transitioned from pilot to permanent resourse on medicine, infomration was added to the “Welcome to Medicine” phamphlet. During admission to the unit, the admitting nurse includes information regarding CodeH as part of the patients welcoming and orientation to the unit.

In the first 22 months there have been 76 CodeH calls. 

Methods 

Evaluation of CodeH consists of three components:

-          survey of patients, families and staff on units where CodeH is implemented

-          analysis of the data collected by the CRNs when a CodeH call is placed

-          structured interviews with patients and families who access CodeH

Using a simple survey tool created by the CodeH steering committee patients, families and staff on the units where CodeH is offered where surveyed to gain an understanding of their perceptions of the service.

Patients and families surveyed were and asked if they were aware of the service, reasons why they might call CodeH and whether they feel safer having CodeH available. There was also space for additional comments.

Staff were surveyed and asked if they were, aware of the service and whether they felt CodeH benefits staff as well as patients and families. Staff were also provided free text space for additional comments.

Additional data was collected by reviewing the call logs of the Clinical Resource Nurses who respond to CodeH. The CodeH calls are tracked by the CRNs. The data tracking include the reason for call, other team members involved, response time, follow up visit with patient/family, and time spent.  The data collected by the Clinical Resource Nurses is being reviewed and organized into themes.      

Currently underway is the evaluation of patients and families who utilized the CodeH system. These individuals are being invited to participate in semi-structured interviews conducted by a trained research assistant. Interview questions will focus on the patients’ or families’ experience of calling CodeH and the impact of doing so. The interviews will be transcribed and coded and thematically analyzed.

Results 

Results of surveys with patients and families indicate that CodeH provides a valuable source of support. 81% of respondents answered ‘very true’ or ‘somewhat true’ to the statement ‘I feel safer with CodeH’

Additional patient and family member written feedback included:

•  “I think this is a very worthwhile project that provides assistance when there doesn't seem to be another alternative for information.”
• “Good idea - I am comfortable asking questions but many people need another avenue.”
• “Thank you for having this kind of service and for making sure that patients are aware of it. St. Paul's has been our hospital of choice for many years, and this just adds to the 'why' we go there when we need medical help.”

Staff survey results indicated support to CodeH. 86% of staff surveyed were aware of CodeH; 66% of staff respondents reported viewing CodeH as beneficial to patients and families as well as to themselves as staff members.

Additional staff member written feedback included:

• “Patient has more ways to find out the answer to their questions. Reduced anxiety.”
• “ Any additional resources are great for nurses and patients”
• “The team ALWAYS works hard on resolutions for complex d/c and other cases. We exhaust all and any possible avenues. Code H almost seems like making us duplicate our work or worse…checking on our work. I think it affects staff morale negatively"

Preliminary results for the analysis of the CRN call logs indicate that primary reasons patients and families call CodeH include lack of clarity about the plan of care, pain management and communication. Further findings will be included in the poster presentation. 

Semi-structured interviews with patients and families who placed a CodeH during their admission are being conducted. Results of these interviews will be analyzed and presented in the poster.  

Discussion         

      CodeH helps to support the philosophical push toward patient and family centred care at Providence Health Care. This evaluation demonstrates that patients and families find the program an important and valued resource. Staff survey results demonstrated that while some staff had reservation regarding the program over half of the respondents found it to be mutually beneficial for staff and patients.

Analysis of the data collected through he CRN call log identified potential areas for improvement for the care team.

Evaluating the experience of those patients and families who utilized CodeH will add important qualitative data to our evaluation.

Limitations of this evaluation include a small survey sample size.

CodeH is a well received patient and family centred care initiative that has the potential to improve care at health care organizations.