Marin General uses a mobile app, Carebook, to keep the entire patient care team up to date.
Care transitions and discharge planning are by nature very multidisciplinary. Besides the patient’s core care team needing to collaborate among themselves, they also need to coordinate with all relevant disciplines, and outpatient care. Previous to Carebook, there was no easy way for people to do that with our existing system. We surveyed our staff and realized that people had trouble learning who else was caring for a patient, communicating changes in discharge plans, and contacting the patient’s care team. It was also hard for people to have conversations around a patient’s care plan. They could write notes in the EMR, but that was for documentation, not for discussions. We could not count on other disciplines keeping up with our notes in the EMR.
Marin General is a non-profit hospital in Greenbrae, CA. It has 250 beds and serves a mainly affluent suburban/rural population with pockets of low-income Latinos, African-Americans, and state prison inmates. Their transitions program began in 2011 and is influenced by the Care Transitions Program and Project RED.
What We Tried
We implemented a mobile communication app called Carebook (http://careinsync.com/) that connects all of the different roles in the hospital. There’s secure messaging among the care team of doctors, nurses, case managers, specialists, and all other disciplines involved in the care of a particular patient. It encourages physicians and staff to share expectations for discharge earlier in the hospitalization, shares concerns about particular barriers to a safe discharge, and creates task lists, by discipline, to clarify what has been done or needs to be done for this particular patient. After testing the app internally, we included community clinics, Accountable Care Organizations, home health agencies and skilled nursing facilities as well and are working to get PCPs added. Attending physicians can also indicate that a patient is to be discharged the following day and a message is automatically sent to the care team to prepare their discharge instructions and do any follow up work they need to do.
This app has had a major impact in terms of communication. Before developing it, we asked physicians, “How easy is it for you to communicate with other members of the care team around changes in discharge plans?” At that point, only 8% said it was easy or very easy. One year after launching this app, 72% of physicians said it was easy or very easy. The hospital has also made this app the primary communication tool for all clinical communications, not just those related to transitions.
Outpatient providers also appreciate the app because they have the ability to easily access anyone on a patient’s care team if they have any questions. Before they would have to call to find out who was on the care team and then wait for someone to call them back. Now they can just send a message directly.
Getting hospital administration to standardize the app as the hospital’s primary communication tool was critical to our success. It wouldn’t have worked if one discipline used the app, but another used pagers, and a third relied on phone calls. To be effective, everyone needs to communicate using the same tools.
One downside to our app is that it’s not integrated with our EMR. Ideally they would be the same system so that you could see the patient’s medical information alongside conversations about their care.