Issue 6 Stories
Clinical Excellence

From Hospital to Home:

Discharge Binders Facilitate a Safer, Smoother Transition for Patients

Picture yourself coming to the hospital for a minor operation. Although the procedure is a fairly routine one, you’re understandably still a bit anxious. You likely will have numerous interactions with caregivers during your time at the hospital, and throughout the process you’ll probably have a lot of information to absorb and a variety of questions to ask. Even after you leave the hospital, you’ll have some important instructions to follow, in order to support the healing process.

Similar scenarios take place every day in hospitals across the country. That’s why Sentara Martha Jefferson Hospital and Sentara RMH Medical Center now provide patients with discharge binders, which include patient education information and instructions to help patients achieve the best possible outcomes following a hospital stay.

What Exactly is a Discharge Binder?

Discharge binders are just one example of the extra steps Sentara Martha Jefferson and Sentara RMH take to help patients throughout the entire continuum of their care. More specifically, a discharge binder is a three-ringed notebook that keeps pertinent patient care information organized in one convenient location. These binders typically contain general health information, lists of any new medications and prescriptions the patient may be taking, additional educational materials they may need, and discharge instructions for when they leave the hospital.

For instance, a patient might receive information from her physical therapist about exercises she should continue to perform after she is discharged from the hospital. This therapy information can be added to her binder as part of her discharge instructions.

Despite being known as a discharge binder, however, the communication facilitated by the binder does not take place solely at the end of a patient’s hospital stay. In many cases, caregivers discuss the contents of the binder with patients and family members, well before patients leave the hospital. This face-to-face interaction helps to reinforce the importance of learning the information and following the instructions contained in the binder.

Why Use Discharge Binders?

“The main goal of the binder is to help consolidate the information that’s given to patients and their families to help with their continuity of care,” says Kelly Via, quality improvement coordinator at Sentara Martha Jefferson. “The binders also can help patients in outpatient settings, which is why hospital caregivers advise that patients take their binders with them to their follow-up primary care visits. We also encourage patients to keep their binder and bring it back to the hospital, should they need to return. Ultimately, the goal is to decrease readmissions while simultaneously promoting and enhancing patient education.”

For the best outcomes, patient education should be an ongoing, rather than episodic, process.

“The binders are a great tool for compiling critical information in one place,” says Heather Galang, RN, quality improvement nurse at Sentara RMH. “At our hospital, we like to call it a ‘transition binder’ rather than a ‘discharge binder,’ so patients come to see their binder as truly encompassing all aspects of their care, rather than as something related solely to one hospital stay. We’re starting to see nursing homes, skilled nursing facilities and home health agencies adding information to the binders as well, which is exactly what we’re aiming for.”

Enhancing the Patient Experience

Patient reception to the binders has been positive at both hospitals, according to Via and Galang.

“At Sentara RMH, we often have patients tell us how beneficial the binders are for them and their families,” says Galang.

Natalie Rinaca, a Sentara RMH patient advocate, recalls having a patient’s daughter show her the binder. “It was stuffed,” Rinaca says. “She had everything about her mother’s health in this notebook and said she refers back to it often—especially if she has a question for a physician. She said it’s a wonderful tool.”

The feedback from Sentara Martha Jefferson patients has been similarly positive—so much so that the hospital is looking to expand use of the binders.

“We currently give these binders to patients who will be discharged to home,” says Via, “but we’re piloting a new program in which we give a binder to every patient who has a stay here.”

Who Pays for the Binders?

Questions have come up at both Sentara Blue Ridge hospitals about the cost of providing the binders to all inpatients. Currently, the binders are funded by the Martha Jefferson Hospital Foundation and the RMH Foundation, respectively. However, as Galang and Via point out, the cost of the binders is minimal in comparison to the significant enhancements they provide to patients. For instance, for many patients, the empowerment the binders offer is helping to reduce the risk and associated cost of being readmitted to the hospital soon after discharge.

Care providers at both hospitals continue to evaluate their use of the binders, looking for ways to make further improvements. At Sentara RMH, about 15 audits per nursing unit are performed each month to help with standardizing the use of the binders.

“This is still very much a work in progress,” Galang states, “and we’re making changes at both hospitals based on feedback from caregivers and patients regarding the design, cost and other aspects of the binders.”

Encouraging and Empowering Patients

Caregivers and patients at both Sentara Blue Ridge hospitals are finding that the binders provide significant benefits—not only by providing a collection point for information, but also by encouraging patients to take a more active role in their recovery.

“These binders are another step in trying to bring all care together across the continuum,” says Via. “Their use supports our mission at both Sentara Blue Ridge hospitals to provide safe, effective care to our patients.”

Genesis of an Idea

The idea of providing discharge binders to all inpatients came to Sentara Martha Jefferson from the hospital’s current president, Jonathan Davis. Davis implemented these binders at a previous hospital where he served after a relative was admitted. The family member expressed a desire to streamline and simplify all of the important information they received as they prepared to go home, and thus the concept of the discharge binder was born.

Sentara Martha Jefferson adopted the idea and began a trial use of the binders in September 2015. The Patient and Family Advisory Council then reviewed their use and provided input before going to the hospital’s nursing leadership for approval and implementation.

Soon noticing the positive effects these binders were having at Sentara Martha Jefferson, Sentara RMH nurses pushed for adoption, and the hospital began using them in August 2016. Their implementation at both facilities is a great example of how the sister hospitals in Sentara’s Blue Ridge Region share best practices and other important innovations to enhance the care their patients receive.

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