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This year, OpenLab and the PODS project will have a presence at Health Quality Ontario’s annual conference, Health Quality Transformations 2017. COme visit us at the OpenLab or ARTIC exhibit table anytime during the day. The conference is on Tuesday October 24, 2017 at the Toronto Metro Convention Centre. For more information on HQT, click here.

Dash_logo A digital platform for PODS is now available. After finding himself in the emergency department with a broken leg, Zack did not know how to manage his aftercare despite the instructions he was given. As a result, he developed a complication and almost lost his leg. His experience made him want to improve the way people are given discharge instructions and prevent this from happening to someone else. The result is Dash MD. Built on the PODS framework, Dash MD is a mobile app that allows patients and families to access patient-centred discharge instructions. It is freely available to patients and hospitals. Find out more at: dashmd.co Read a case study of Dash MD in use at Markham Stouffville Hospital here.

To help hospitals kickstart their local PODS projects, we are applying for a grant through the ARTIC program of Health Quality Ontario and the Council of Academic Hospitals of Ontario (CAHO). If successful, participating hospitals qualify to receive $45,000 in funding. We are excited to say that of the 79 project proposals received by ARTIC in July 2016, PODS is among a small number invited to submit a full application, which is due October 18, 2016.

This is where you come in. If you are an Ontario hospital and interested in adopting PODS across your organization, or in a specific department or program, please get in touch with us. We are looking for one hospital in each Local Health Integration Network (LHIN) to be a ‘spread partner’ in the ARTIC grant. If the application is successful, spread partners not only receive funding to support their local PODS project, but also play a pioneering role in reinventing discharge practices in their LHIN. To qualify as a spread partner, please fill out the expression of interest and send it to us by September 30, 2016. In the event that there are multiple expressions of interest within a LHIN, we will go with the hospital that makes the most compelling case.

Information Session:

We will be hosting a webinar on Friday, September 16, 12-1pm to help answer any questions you might have. Please email us to get the dial-in information.

Expression of Interest:

  1. Download Expression of Interest form
  2. Fill it out
  3. Send to us via email by September 30, 2016

  The PODS team will be presenting the development and implementation of PODS at two venues this September, 2016. First, on September 8th: Please join us for the first of a series of City-wide Quality Improvement & Safety Rounds. The topic on September the 8th (12:00 – 1:00) at 525 University Ave. (Rm 630) is: Implementing Patient-Oriented Discharge Summaries (PODS): A Multisite Pilot across Early Adopter Hospitals **Presented by C-QuIPS and the TASHN hospitals, monthly City Wide Quality & Safety Rounds, will be hosted by different hospitals on a rotating basis, and broadcast through Ontario Telemedicine Network to all TASHN hospitals. Then, on September 21st: Join PODS Project Co-Leaders, Shoshana Hahn-Goldberg & Tai Huyhn on September 20-21 in Toronto at the 4th Patient Experience Forum. This is the only Canadian event where passionate, devoted patients & professionals from across the country gather to address crucial issues impacting the patient experience and all those involved. The PODS presentation is on the September 21 at 10:45am For more information on the forum visit: forum website

The winner of UHN’s 2016 Local Impact Team award goes to… Toronto Rehab’s Lyndhurst – Spinal Cord Rehab Program’s PODS team!!! The team lead by Sandra Mills and Heather Flett, along with project lead Melanie Allapat and working group members and PODS faciltiators Stacey Budden, Helen Morris, Dionne Rockley, Carol Scovil and Anella Ventre accepted the award last evening at the 2016 UHN Annual General Meeting from Dr. Michael Baker and Dr. Peter Pisters. The team was recognized for their dedication to ensuring patients are prepared for and safe in the lead up to discharge from inpatient rehab in the spinal cord rehab program! Key Achievements include: · Patient partnership in co-design · Patient Advisors who ran focus groups and conducted phone interviews with past patients and family members · Patients as active participants in discharge planning · Personalized spinal cord discharge summary · Use of teach-back style to clarify understanding and support self-management · Feedback mechanisms for team members to adjust treatment for gaps prior to discharge · 97% PODS completion rate for patients at Lyndhurst · Continuous learning and improvement · Use of implementation science to take a pilot into full adoption across the program We would like to recognize the entire team, the Spinal Cord Rehab Program’s staff and especially the patient advisors Joshua Forbes and Anthony Simas! Congratulations Lyndhurst and Team PODS for receiving this award!!! lyndhurst awawrd

This Post is shared with us via the PODS early adopter team at Holland Bloorview Kids Rehabilitation Hospital (HBKRH) in Toronto. HBKRH were involved in the pilot of PODS and have since spread it’s use and implemented it within the hospital’s electronic system. The following story was posted on their internal website. Thank you for sharing:   Holland Bloorview aims to improve communication with clients and families at discharge

HB_PODS PODS Champions (Anna Lam, left, and Shivonne Seelochan, right) working together and completing the Patient Oriented Discharge Summary (PODS) for a SODR client.​  Transitioning to home is a vulnerable time for our clients and it is important that information that our clients and families need to know is clearly communicated. Two years ago, the Toronto Central LHIN commissioned OpenL​ab (at the University Health Network) to understand the challenges families face around the time of discharge. The process involved the input of clients, caregivers, healthcare providers, medical education and design professionals. Through their work, the Patient Oriented Discharge Summary (PODS) was developed in order to help communicate discharge information that is most relevant and actionable for clients/families. PODS helps clients and families effectively manage their health after discharge from hospital. This tool addresses 5 pieces of essential information:

  •          Signs and symptoms to watch out for
  •          Medication instructions
  •          Appointments
  •          Routine and lifestyle changes
  •          Telephone numbers and where to go for more information

In 2015, HBKR adapted the PODS prototype tool and created a form within the electronic health record. It was piloted by staff across BIRT and SODR and was well received by our clients and families. Last month, a new, revised PODS was fully implemented on all 3 pediatric inpatient departments as well as in Day Program. Danielle Lumibao has led the implementation of this project and with the help of the PODS Unit Champions (Anna Lam, Shivonne Seelochan, Karen Fabris-Silva, Caroline Ivorra and Nicole Horton) they have all endeavoured to ensure that PODS is incorporated into our discharge process. A copy of PODS is given to clients/families prior to being discharged. PODS supports the HBKR values and the 2012-2017 Strategic Plan. It also elevates client safety by ensuring our clients and families have clear, concise and readily available information post discharge. Efforts are underway to make the PODS tool available to clients and families via the connect2care portal. Stay tuned!

PODS at TRI featured in Hospital News – Life after spinal cord injury: New self-management tool helps patients transition home

March 4, 2016

In a fantastic piece in Hospital News, March 2016, PODS is described as a new standard of care for spinal cord injury patients. TRI at Lyndhurst participated int he early adopters pilot of PODS and their fantastic team, including two patient advisors, have established a system that is facilitating a patient-centered discharge for spinal cord injury patients. Their program includes a patient meeting with a neutral facilitator held in teach-back style. Results of their program show that patient confidence at discharge has doubled.   Read the full story, featuring one of the patient advisors involved in this project, in the current issue of Hospital News: here  

PODS Video Stories – Video stories showing PODS implementation at three early adopter sites

October 20, 2015

Each early adopter site was unique and they adapted PODS to meet the needs of their patient population. These three films depict PODS implementation at three of the early adopter sites.   Toronto Rehabilitation Institute (Lyndhurst site) https://vimeo.com/142992827   The Hospital for Sick Children (Unit 4D – Cardiology) https://vimeo.com/142992828   St. Joseph’s Health Centre https://vimeo.com/142992829      

Guest Post – A PODS Personal Experience

October 16, 2015

Author: Valerie Mais

Yes. Ok. Nod. Nod. Ok. Nod. No, I don’t think we have any questions…
My sister and I were accompanying my mother to her pre op appointment. One by one, a different healthcare provider came to speak with us about a different aspect of her surgery, give us photocopied, text-heavy leaflets and booklets for further reading, and answer any questions we had. The anxiety and emotional stress of why my mother needed surgery was suddenly shelved in order to process how we were to prep on days 3-2-1 beforehand, and what would be expected afterwards. We left with a library of handouts, pages of my scrambled, handwritten notes, and our heads buzzing with information that had dissipated into white noise.
Unfortunately, this was typical of how we left most of our meetings at the hospital – and English is our first language, we all have post-secondary degrees, and I work in healthcare. I cannot imagine what the experience may be like for those raw to this system, the language, have lower levels of health literacy, or are alone.
The transition home after surgery was a frantic mess. When was the last dose of that med given in the hospital? Can’t remember. Can she take this pill at the same time as that one? Don’t know. She feels hot – is she too hot? Should we go to the ED? Can we get it down on our own so she doesn’t have to sit in a sea of sick people for eight hours? The Tylenol isn’t really working to manage her pain – can she take Advil? Did she take enough steps today? Does her surgical wound look infected? How do we get her to drink more water? What is normal? When does normal happen?
When you step out of the hospital, your title of patient, family member, or friend expands to nurse, doctor, physiotherapist, pharmacist, dietitian, and more. You are the care team, taking vitals, relieving pain, fevers, creating and re-creating med schedules, administering meds, increasing mobility, making meal plans, monitoring side effects – and all the training you had were in those handouts you tried to read, and in those conversations you tried to listen to, but were probably too anxious and upset and tired to absorb it all.
I was lucky to once work at OpenLab, and be aware of the Patient Oriented Discharge Summary project that was budding at the time. I remember the project team taking a human-centred design approach, and partnering with patients right from the start to understand their hospital-to-home experiences, and co-design a solution to meet their needs. My family and I desperately needed a tool to help us manage the mass of information and questions that left our brains numb, so I downloaded the PODS template to do just that.
It’s a single-paged pitstop that centralizes key pieces of information, previously flown at us from different directions: a med schedule, possible symptoms and when to go to the ED, activity and dietary changes, appointments, and a contact list. The use of iconography helps to both visually chunk the information, and is almost calming, because it’s fun to look at. PODS helps to mediate the incessant mad scramble through pages and pages of notes, leaflets, and booklets, and the tireless jog through your memory trying to recall what he or she said about this and that. Tending to the care of your loved one is made easier, since you are now equipped with a concise reference guide to do so. And with PODS as our inspiration, we created additional paper-based tools to help manage my mother’s care: a checklist of do’s and don’t’s on the days leading up to surgery, badges awarded when post-surgical discharge goals were met, and an hour-by-hour timeline to keep track of when meds were due and given.
Today, we can print 3D blood vessels, use wearables to detect and track physiological indicators, and have robots deliver meals and blankets to patients. Yet information given to patients, families and friends for managing their care post-discharge is still overwhelming, and laden with text-heavy handouts. Instead of empowering people to be aware and in control of care at home, they can amplify the stress and anxiety already felt. PODS is a simple, streamlined tool that helped my family organize and digest the information critical to the care of my mother post-discharge, and also sparked other information redesign ideas. I look forward to the continued spread of PODS, and translation to the many facets of our healthcare system!

The PODS Early Adopter Team Made the Honour Roll for the Minister’s Medal Honouring Excellence in Health Quality and Safety, Putting Patients First

October 14, 2015

to read more about the winners of the medal and all honour roll recipients, visit the ministry of health and long term care, here. ministersmedal   A big thank you to all our early adopter teams: TRI: Josh Forbes, Anthony Simas, Melanie Alappat, Heather Flett, Sandra Mills Bridgepoint: Lily Yang, Leo Lafaro, Agnes Tong, South Acquired Brain Injury Team MSH: Penny Dooks, Christina Fabbruzzo-Cota, Sara McCutcheon, Sari Markel, Davina Lau, Chaim Bell, Christine Soong HBKR: Joanne Maxwell, Lisa Kakonge, Kim Bradley, Laura Williams, Shawna Wade HSC 4D: Jennifer Kilburn, Lauren Scavuzzo, Jullian Chen, Leah Costa HSC 8B: Jennifer Moloney, Jennifer Goodwin, Kathleen Magee SJHC: Ryan McGuire, Jenni Glad-Timmons TEGH: Roxanne Riendeau, Linda Young, Robert Lee SMH: Patrick O’Brien, Anne Trafford, Mike Feeman, Kenneth Pace, Charlie Yang TC LHIN: Cynthia Damba OpenLab: Shoshana Hahn-Goldberg, Karen Okrainec, Tai Huynh, Najla Zahr, Howard Abrams

The process of developing PODS has been published in the Journal of Hospital Medicine

October 10, 2015

The development of PODS was a collaboration between OpenLab, the TC LHIN, healthcare providers, and many patients, families, and caregivers. The process was overseen by an advisory group with a patient member and involved innovative techniques to get feedback from hard-to-reach patients and gain a deeper understanding of the patient experience after discharge. A description of the development of PODS has now been published in the Journal of Hospital Medicine and can be accessed here: link to article

Join an RCT to study the impact of PODS on discharge quality and outcomes

September 8, 2015

Engaging patients and/or caregivers when providing discharge instructions has been found to improve comprehension and retention of discharge instructions.   However, whether improving the quality of discharge instructions leads to improved patient satisfaction and patient outcomes is not yet clear. We are planning an RCT using PODS later this fall and we are looking for hospitals to join us. We will train you on how to use the PODS, help run the trial, and collect data from patients post-discharge.  The only condition is that you have patients who will be discharged with COPD, CHF, pnemonia, stroke, hip fracture, or hip or knee replacement that are not yet receiving PODS. If you are interested in being part of this important study, contact us here.

Results from the Early Adopter Pilot

August 31, 2015

From January through March 2015, a group of early adopter hospitals in the TC LHIN worked together with OpenLab to implement PODS in selected departments, representing a cross-section of patient populations and hospitals including acute care, academic, community, surgery, rehabilitation, and pediatrics. Rapid PDSA cycles were used to implement and refine PODS at each site. Measures of the process, patient experience, and provider experience were collected pre- and post-implementation using structured surveys. Results from early adopters show marked improvements in patient experience, with minimal burden on providers. PODS and related resources are now freely available under Creative Commons for anyone to use, modify and improve upon. In the first month post-implementation across the 8 early adopter groups, over 200 patients across the TC- LHIN received PODS. Among patients given PODS, discharge communication experience was overwhelmingly positive across multiple dimensions. The average percent of patients who agreed or strongly agreed to statements regarding understanding their discharge instructions was 92 percent. results_graph Provider experience results were also positive. Over 90 percent of providers found PODS easy to use and valuable for patients. Over 80 percent felt it did not add to their workload, but rather improved discharge teaching by ensuring consistency and supporting communication with the patient.

PODS presented at the Society for General Internal Medicine Conference

April 23, 2015

Led by OpenLab Senior Fellow, Dr. Karen Okrainec, the development of the PODS project was presented at this year’s SGIM conference held in Toronto. To find out more about the conference, click here. Majority of the attendees at SGIM are GIM physicians from the United States, with several Canadian and International physicians also in attendance. The PODS project drew a large audience and generated a lot of interest. Many physicians were directed to this website for more information. It turns out that problems with information communicated to patients at discharge is a world-wide phenomenon. Even large EMRs that have some mechanisms in place to generate patient directed instructions, have no way to implement proper design elements that are critical to making instructions usable and understandable for patients (such as visual communication and space for patient notes). Some of the PODS early adopters are working on this right now, so stay tuned to this PODScast for updates in the near future. We hope that the SGIM physicians use the PODS tools in their organizations to improve patient communication at discharge. If you do, let us know and provide feedback through the contact form on this website. We want to hear from you. image

The Early Adopter Process

 

April 15, 2015

How does one go about spreading an innovation? PODS was designed by OpenLab along with patient, providers, and caregivers. We knew they liked it and we knew it was important. It was refined to the point where it could be tested in the clinical environment. Together with the TC LHIN, we came up with a unique way of spreading it and evaluating how it would work in various healthcare settings – a group of early adopters. Early adopters are defined as people who start using a product or technology as soon as it becomes available. In our case, they were organizations who wanted to provide PODs to their patients. This group of hospitals came together to rapidly prototype PODS in the clinical environment. The hope is that this early group of champions will help refine the PODS and spread it within their organizations and beyond. OpenLab served as central communication, development of central resources, coordinating a collective evaluation framework and generally supporting all groups with the goal of successful pilot implementation of PODS in a department of each early adopter hospital within three months – a tall order. Too often, communication between healthcare organizations is lacking, and innovations being developed and trialled in one place, are not learned from across the board. The early adopter model attempts to combat that by collaborating early and sharing learnings within the group and with the community as a whole. One of the central resources developed was a website, open to all, that housed a version of the PODS tool and central resources developed for and by the early adopter group. Over the past three months, each early adopter hospital took PODS and modified it as they saw fit considering their own environment, their own IT constraints, and their target population of patients. At the end of the three months, we came together to reflect on the early adopter process. Did it work? How could it be improved upon? Could it be applied to other initiatives in the future? The various early adopter organizations expressed that each population of patients is unique and that through this process, PODS will be more sustainable because it was adapted to meet patient needs. Participants benefitted from having central resources on hand. Some organizations have included PODS in their strategic plan for the upcoming year. The early adopters got together once a month at OpenLab to share and learn from each other. Participants found this helpful. One area where the forum was particularly helpful was spread. When the organizations look to spread the use of the tool to other departments in their organization, they can learn from other organizations who piloted in similar. Additionally, there was one section of the tool that posed barriers to majority of the groups. We were able to come together and create several solutions that would work. Future implementers of PODS will definitely benefit from this experience. The short time frame (3 months) to implement had its pluses and minuses. It forced and enabled the group to get a large amount of work done very quickly. The short time limit was a change in how most groups would generally implement an initiative. Organizations were forced into very rapid implementation cycles and as such ended up with a more robust process. One of the challenges resulting from the short time line is that many organizations brought more resources onto the project for a short time and are now worried about sustainability. Another challenge was that the groups were unclear about how much flexibility there was to adapt the current prototype. In truth, the early adopter process was new for OpenLab as well and at first, we wanted to have all groups keep to the original form as closely as possible. We saw this was difficult and ended up allowing a lot of flexibility. In the end, the forms all have a lot of similarities and most include all of the essential elements of the original content and design. File 2015-03-30, 8 07 12 PM File 2015-03-30, 8 07 54 PM File 2015-03-30, 8 03 24 PM File 2015-03-30, 8 06 01 PM

The PODS form is now available in multiple languages (PODS)

 

March 17, 2015

The PODS form is now available with headings in 15 languages – English, French, and the 13 other most common languages spoken in Toronto. To use the form, click here and use the drop down menu in the top right corner of the form to select the language of your headings.

SCRP Best Practice Forum: Improving Patient Transition to the Community: The Rationale for a Patient-Oriented Discharge Summary (PODS)

 

March 12, 2015

12:00 pm E.T

Toronto Rehab, Lyndhurst Centre, Lecture Room A and B

OpenLab and collaborators at Toronto Rehabilitation Institute (TRI), early adopters of patient-oriented discharge summaries (PODS), will co-present the PODS project at the TRI Best Practice Forum

Presenters:

Shoshana Hahn-Goldberg, Post-Doctoral Fellow – OpenLab, UHN Melanie Alappat, PODS Implementation Lead Josh Forbes, Patient Advisor Anthony Simas, Patient Advisor Sandra Mills, Patient & Family Educator Heather Flett, Advanced Practice Leader

SICK KIDS unit 4D has begun their PODS pilot

February 25, 2015

Each PODS early adopter site is making PODS their own. The cardiology unit 4D at the Hospital for Sick Children is spreading awareness through posters and t-shirts. 4D_twitter_pic  

PODS is being implemented in 8 hospitals in the Toronto Area

February 2015

These 8 hospitals in the Toronto area are currently implementing PODS:

  • Bridgepoint
  • Mount Sinai Hospital
  • Sick Kids
  • St. Joseph’s Health Centre
  • St. Michael’s Hospital
  • Toronto East General Hospital
  • University Health Network

Stay tuned to find out how PODS is working in different discharge environments.

Patients Love PODS

May 2014

“This is a great piece. You guys are doing an awesome job. This would have saved me so much anxiety and fear of doing something wrong when I was discharged. I didn’t want to bother my doctors and went on a hope and prayer. Even my home care people weren’t always sure of what to do. Again this would be a great step forward in easing patients’ fears especially senior citizens. Great work. Thanks for caring!” – patient

Patients Explain the Importance of Family and Caregivers at Discharge

February 2014

“My primary caregiver is my husband. He has been amazing! From first recognizing that I needed to go to the hospital then spending a good part of every day with me. He is exhausted physically and emotionally.” – patient “My son helps me. He comes over and makes sure I take my meds. My daughter-in-law cooks me good food.” – patient “Since I have been home, I haven’t been able to do much. On a scale of 1 being good and 10 being bad, I feel 5. It is fun but boring to be home because I can’t do activities like running, skipping, dancing, and swimming. The people who are helping me with my care are my family.” – patient “Saturday my family, my son in law, daughter, granddaughter, and grandson everybody at home. We put the Christmas tree up everyone helping to put the decorations. The reason I’m writing this because when I am was sick my family they given me a lot of support and strength.” – patient

Patients Express Dissatisfaction With Current Discharge Instructions

November 2013

“We were given verbal instructions about what we should do in certain situations, for suture care, etc. Printed instructions would have been more helpful because we were exhausted by the end of her stay; thus we were not taking in the verbal instructions very well. If something is important enough to mention at discharge, it really should also be written down.” – caregiver “What a terrible start to the day. (My husband) has his own agenda of what I should and should not be doing. Here again instructions from the hospital would have been helpful. Cross words have been spoken and I know neither of us is at fault. I seem to cry very easily.” – patient “A discharge form in ‘plain English’ should be standardized.” – patient

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