What Patients Need to Remember After Leaving the Hospital

Wall Street Journal
December 1, 2015

 

When Emily Monato went to see her neurosurgeon in October, she learned she had a potentially fatal lesion in her brain and needed surgery.

After receiving disturbing news, many patients retain little of what they were told, doctors say. But Ms. Monato was able to take advantage of an unusual new tool her physician gave her: a six-minute video from her office visit comprising a series of screen captures of her brain MRI transmitted from her doctor’s computer along with his assessment. Using an app on her iPhone, Ms. Monato watched and listened as the surgeon explored images of her brain, using his cursor to outline a walnut-size mass of vascular tissue he said needed quickly to be removed.

Then she watched the video again and again. At least five times. Replaying the video helped her “grasp these big chunks of information” and allay at least some fears, such as, “Am I going to for get how to count to 10?,” she says.

Ms. Monato, 49 years old, shared the video with others. She told her anxious father, a retired doctor in Florida: “You know, Dad, I am not even going to try to explain. Please watch the video.” She encouraged her friends and even her children, ages 8 and 12, to see it, too.

 Emily Monato, left, who had brain surgery in November to remove a brain lesion, is seen with Cynthia Liapes, a nurse-practitioner. Ms. Monato participated in a project at Lenox Hill Hospital where parts of office visits along with discharge instructions are recorded and the digital tape is given to the patient to access at home. One goal is to improve outcomes by helping patients remember more of their medical information. Photo: Kenneth Court/Lenox Hill Hospital .Ms. Monato, who lives near Princeton, N.J., is a participant in a project by David Langer, chief of neurosurgery at Lenox Hill Hospital in New York City, to use technology to record crucial steps of a patient’s experience in the hospital. Dr. Langer, who helped develop the software with a tech partner, says he believes it takes some of the confusion out of doctor-patient exchanges.

Patients “would go home and call back and say they didn’t understand, and then ask me the same questions,” he says. Part of the problem: “Doctors often do a terrible job at educating their patients.”

Research shows patients don’t absorb much of the medical information they receive from their physician and are often wrong about what they do remember. Patients “immediately” forget 40% to 80% of what the doctor told them, according to a 2003 paper in Britain’s Journal of the Royal Society of Medicine.

Some 50% of patients discharged from hospitals make mistakes in their aftercare with medications, and many end up back in the hospital, says Brian Jack, chief of family medicine at Boston Medical Center, who is leading a research effort he hopes will retool the discharge process in U.S. hospitals. “We throw papers and throw words at patients. It is crazy to think they would understand,” he says. This is especially true of older patients and those who are depressed.

 David Langer, chief of neurosurgery at Lenox Hill Hospital in New York City, makes sophisticated video recordings of office visits that allow patients to review at home their MRIs and CT scans, along with his assessments. Here he reviews a patient’s images.l Photo: Kenneth Court/Lenox Hill Hospital .Dr. Langer’s neurosurgery unit at Lenox Hill Hospital has also begun making digital videos for patients when they are discharged and has launched a clinical trial of the program to test if it improves outcomes. The trial, which plans to enroll 200 patients, gives half the patients standard, printed discharge instructions. The rest get the printed instructions along with a video that contains their CT scans and MRIs, and walks them through what they need to do. About 110 patients have so far participated.

On a recent weekend, Cynthia Liapes, a nurse practitioner at Lenox Hill, sat in front of a large Apple computer to prepare Ms. Monato’s discharge following her surgery. Ms. Liapes, who cared for Ms. Monato throughout her stay, looked into a webcam and began with a jaunty, “Hi, Emily, it is Cynthia,” then plunged into detailed instructions. As a picture of Ms. Monato’s surgical wound flashed on the screen, the nurse warned her, “It will be tender,” but she could still wash her hair.

At the Cullman Regional Medical Center in Cullman, Ala., an electronic-discharge system called Good to Go, in which nurses make an audiotape of the dos and don’ts at the patient’s bedside, has been widely implemented.

Cheryl Bailey, the chief nursing officer at Cullman, says the program has made both nurses and patients focus more on discharge. Nurses, for their part, put in more effort because they know their supervisors may review the tape later, she says. However, only about 14% of patients use it once they get home and she isn’t sure why.

Vocera Communications Inc., VCRA 1.41 % the San Jose, Calif., maker of Good to Go, said in a statement that it has tracked “exciting” results, including declines in re-admission rates among the 20 institutions using the program. The company said patients are more likely to use the discharge tool when a family member also has access to the tape, which can include audio and video components, or when the patient receives a post-discharge phone call.

 At Lenox Hill Hospital in New York City, the neurosurgery unit is testing whether sending patients home with a video recording of their discharge instructions can help improve at-home aftercare and reduce hospital readmissions. North Shore-LIJ Health System, which owns Lenox Hill, hopes to expand the use of electronic discharge to additional units at Lenox Hill and other hospitals it owns in 2016. Photo: North Shore-LIJ Health System .Dr. Langer and his team at Lenox Hill say that at first only 40% of patients were using their discharge videos. Now, before patients leave the hospital they are shown how to access the system. They get a phone call at home to check if they have watched the videos or need help doing so. Currently, about 90% of patients are tuning in to their electronic-discharge instructions, he says.

This year, North Shore-LIJ Health System, which owns Lenox Hill Hospital, gave Dr. Langer and his team its President’s Award for Innovation for his virtual-office-visit and electronic-discharge systems. North Shore-LIJ said it had invested about $1 million to help develop the software and to fund the clinical trial. In 2016, North Shore LIJ hopes to expand the use of electronic discharge to additional units at Lenox Hill and other hospitals it owns, a spokesman said.

North Shore-LIJ holds the patent for the systems. Dr. Langer says he invested $50,000, including his own money and funds donated by patients, in developing the software. He and his tech partner at the hospital, Kenneth Court, have a 50% ownership stake in the systems.

Other doctors in Lenox Hill’s neurosurgery unit have also begun using the virtual-office-visit software. John Boockvar, a specialist in brain tumors, says he uses the program for patients with complex tumors. Some patients “can have neurocognitive disorder from their pathology. They are overwhelmed by the diagnosis,” he says.

But Mitchell Levine, chief of spinal neurosurgery, is concerned the rise of technology in health care could distract physicians from their main task: communicating on a human level with their patients. “I basically like to talk to the patient, that is my style,” he says. Although he may at some point begin to use the virtual-office-visit software “incrementally,” for now he prefers to “stare my patients in the eye and tell them what I have to do,” Dr. Levine says.

Days after being discharged from Lenox Hill to a rehabilitation facility near Princeton, Ms. Monato said she was feeling much better. She said she received a new videotape from Dr. Langer containing her post-op MRI and his assessment of it. “I devoured it because I wanted to know what my brain looked like” with the lesion removed, she says. “A picture is worth a million, not a thousand, words, and so many of my questions were answered by seeing the images,” she adds.

Ms. Monato, who is a principal at Cooley Monato Studio, a New York architectural-lighting-design company, recovered relatively quickly and was released to go home the Saturday before Thanksgiving. She says she has been easing back into her old routines—cooking for her family and even participating in a conference call with her office staff. There is still substantial numbness on her left side, mostly as a result of the surgery and the location of the lesion. But she and her doctor are hopeful she will get back to normal again. Ms. Monato plans to return to work in a matter of weeks.

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