PURPOSE
To improve veteran surgical literacy, satisfaction, and overall outcomes.
BACKGROUND
For years, discharge education at the New Mexico VAHCS consisted of a fill-in templated non-specific and limited facility wide CPRS note written above an 8th grade reading level. Specific surgical instructions were not provided regarding drain/catheter/ostomy/wound care, activity and bathing instructions, and signs and symptoms to notify the provider. This resulted in post-discharge anxiety, provider calls, and avoidable re-admissions.
METHODS
Nurse Navigator/Patient Educator position was created and filled with intent to create discharge education database specific to diagnosis and procedure, 1:1 patient centered education, and direct access to subject matter expert. The Navigators collaborated with surgeons to develop concise post-operative, evidence- based education, which included easy to read diagrams, 8th grade reading level, and 14 font. Packets were approved through the VHEC/I committee for distribution and stored on the VA Intranet for afterhours ward access to ensure consistency.
RESULTS
28 educational packets were created for the most common surgeries completed to customize education to fit individual needs of the Veteran. Each packet contains basic information regarding the procedure and wound care, but is customizable to include specific drain, catheter, or ostomy teaching. The Navigators meet with the Veteran prior to surgery to develop trusting relationships and begin the education process. After surgery, they visit daily to reinforce education with teach back demonstrations and encourage self-care. Family members are included in education sessions and are provided time for questions. The Navigators ensure veterans do not leave the hospital without necessary equipment and medications. As a result, the NMVAHCS has experienced improvements in the Survey of Healthcare Experiences of Patients (SHEP) scores. Prior to improvements in the educational process, SHEP scores related to discharge education identified areas of concern. After hiring Nurse Navigators, SHEP scores for discharge information increased to 90.3%. General Surgery 14-day readmission rate improved (2.9% in FY 21 to 1.7% FY 22); and 30-day readmission rate improved (12.8% FY21 to 8.7% FY 22), despite increased operative volume.
IMPLICATIONS
Providing Veteran Centered Care with comprehensive education improves selfcare, patient satisfaction, and decreases avoidable readmissions.