Overcoming New Challenges in Patient Communication

Health literacy — the ability to understand health information from a clinician — is vital in keeping patients healthy. For example, if patients don’t understand how to take medicine, they may not do it correctly … and end up hospitalized with preventable complications or exacerbations of their illness.

HUP clinicians and staff across a variety of disciplines have risen to new challenges in patient communication this year due to changes in practice wrought by the COVID-19 pandemic — from helping stroke patients navigate virtual follow-up visits, to communicating clearly about COVID, and more.

Since this spring, COVID-19 itself has raised complex needs to communicate with patients about keeping safe, or managing their care if they were infected. “It is always challenging to provide complex health information in a manner patients and families can understand, but COVID put us to the test,” said Carolyn Cutilli, PhD, RN, patient education specialist. “Complex information changed daily, was often communicated virtually and needed to be created quickly.”

To minimize exposure risk, when a patient is COVID-positive, traffic to their room has been kept to a minimum.  As a result, those who entered the room more frequently often held the responsibility of keeping patients informed.  Holly Bischof, BSN, who works on Silverstein 9 but was part of the team on Rhoads 4 when it was a COVID unit, often took on a lead role in helping patients understand COVID. Bischof clarified information patients heard or saw on TV and tried to provide reassurance, in language they could understand.  She also spoke with family members outside of the room: “Tell me what you know about COVID and let me help clarify.”

Physical therapists such as Alexander Arrow, DPT, sometimes served as a communication go-between for care teams and their COVID-positive patients. “We’d review a patient’s medical plans with the clinical teams and then talk with the patient in the room, using simple language,” Arrow said. PTs would also reach out virtually to family members to keep them in the loop during visitor restrictions. For example, when a patient was nearing discharge, PTs used tablets to virtually demonstrate to families what the patient could or couldn’t do physically to better explain the help a patient would need if discharged to home.

Making Patient Information Clear and Accessible

When there is conflicting information about a health condition and its treatments, patients often wonder who or what to believe. That was especially true in the case of COVID. How would they know if they were still contagious? Do they need to be retested? “Patients had questions but weren’t sure where to get answers,” said Joel Betesh, MD, VP of Graduate Medical Education for UPHS.

To help get this information out to patients, a multidisciplinary team worked together to create an information sheet — something simple that patients could easily understand. They worked together to thoroughly translate a recent report about COVID isolation and retesting practices by Penn Medicine’s Center for Evidence-Based Practice (CEP), Betesh said. The evidence-based information was all there but “it was meant for clinicians with a scientific background, not patients,” Betesh said.

Betesh worked with Judith O’Donnell, MD, of Infectious Diseases; and Matt Mitchell and Nikhil Mull from the CEP, and Cutilli, to put together a simplified version. “There was lot of drafting and redrafting,” Betesh said. In fact, the final version “is unrecognizable from the first draft.” Part of the challenge, he added, was that the information about COVID kept changing.

The final product — which was also run past patients including a member of HUP’s Patient and Family Advisory Council (PFAC) to ensure that the messages were clear — is available in PennChart and accessible by any clinician. Betesh has already used it many times, helping patients understand that “they did not need repeat COVID testing to determine they were no longer infectious.”  

Making the Transition to Virtual

For the large swath of patients who switched to virtual appointments since the onset of the pandemic, not everyone found making the switch to telehealth appointments easy. “For some of my stroke patients, having a virtual visit was just not clicking,” said Rebecca Z. Burdett, CRNP, MSN, of Neurology’s Stroke Division. Indeed, just explaining how to prop up a phone so the doctor could see them move “was taking up a large portion of the visit.”

Looking online for ideas, Burdett discovered that articles on how to do a virtual visit were primarily geared to clinicians, not patients. So she and neurologist Qingyang (Kristy) Yuan, MD, decided to create tools of their own to make the transition as easy as possible: discharge instructions about virtual visits and a video demonstrating ways to ensure a successful telemedicine visit.

In the discharge instructions, “we let the patient know that the follow-up visit might be virtual, what that meant, and how to easily connect with BlueJeans [videoconferencing software].” Burdett worked with Laura Stern, MD, as well as neurology residents to write the guidelines and then with Cutilli to ensure they were written on an understandable level.

For the video, Burdett again teamed up with Yuan as well as Penn medical student Clare Teng to write the content for the video (with tips like “face a window; do not have one behind you”) and then asked Cutilli to review the content and video to make sure it was “appropriate for Penn and for patients with various cognitive abilities,” Burdett said. Her suggestions included slowing down the pace of the video so patients could fully hear and understand instructions and using closed captioning.  The final video — which continues to serve as a “how to” for stroke patients — clearly explains the ins and outs of virtual visits.