Tracy Bertiz, DNP, ACNP-BC, CHFN
The Center for Nursing Research and Innovation at Mount Sinai recently interviewed Tracy Bertiz, DNP, ACNP-BC, CHFN, Nurse Practitioner at Mount Sinai Fuster Heart Hospital, about her quality improvement initiative, “Improvement of Nurses’ Ability in Addressing Low Health Literacy to Reduce Hospital Readmission in Adult Heart Failure Patients.” Presented as a poster at Nursing Research Day 2023, the findings were published last month as an abstract in the journal Practical Implementation of Nursing Science.
What sparked the idea behind your project?
As a Cardiology Nurse Practitioner, I’ve always considered the frequent hospital readmission of our heart failure patients a big challenge. We call them our “frequent flyers.” We have multiple initiatives addressing this issue, but the readmission rate has remained high in spite of our best efforts. Since health literacy can play a large role in the gaps in care experienced by heart failure patients, my project team and I decided to teach nurses and other care team providers how to assess health literacy, and how to use targeted communication strategies to help patients better understand discharge instructions. We chose to work with staff at Mount Sinai’s Transitions of Care Center (TOCC) because of their important connection to patients as they move from one setting to another. Our goal was to decrease the 30-day heart failure readmission rate by training the care team to first assess the health literacy of their patients, and then to offer practical discharge instructions tailored to each individual’s level of understanding. We found that patients benefitted from their care providers using simple language, which helped them develop self-efficacy and better navigate the health care system.
Translate the discharge instructions into simple terms:
- Limit the information to three-five key points at a time.
- Ask the patient to have the medication bottles in front of them, then have them read the label of the medication bottle.
- Ask the patient to repeat to the TOCC nurse all the discharge instructions given. “Tell me that you have understood and what you need further explanation on. I want to ensure I explained the instructions clearly.”
- Summarize all the information at the end of the conversation.
*The above is a sample from the virtual training.
How did teamwork help make the project a success?
The TOCC team was a catalyst for change, and the teamwork we built helped us achieve remarkable results. Additionally, the commitment of the TOCC to close the gaps in care for patients transitioning from hospital to home helped make this project sustainable. I want to acknowledge my Doctor of Nursing Practice (DNP) project team, Tara Cortes, PhD, RN, FAAN, and Chenjuan Ma, PhD, RN, at the NYU Rory Meyers College of Nursing. Their constant mentoring helped me succeed in this endeavor. I also want to recognize the leadership and staff at the TOCC: Esther Pandey, DNP, MS, RN, System Vice President of Care Transitions; Carl Jin, MSN, MPA, RN, Director of Clinical Services; Arzellra Walters, MA, CPNP, RN, Nurse Manager; and the Center’s fantastic nurses. They were instrumental in implementing the initiative. This project would not have materialized without them.
What have you learned from your project?
I have learned that TOCC nurses play a significant role as frontline health care coaches for patients across the Mount Sinai Health System. Effective communication is critical to patients’ adherence to their medications, regular follow-up with health care providers, and self-care of chronic medical conditions.
What new ideas are you hoping to pursue after this experience?
I want to continue to gather and share insights about the importance of assessing health literacy in all patients, regardless of their educational background. Awareness of health literacy can enable care providers to communicate more effectively, but this is only one part of the equation. I think it’s also important to assess patient self-efficacy after receiving instructions targeted to their health literacy level. I would like to investigate whether particular methods of teaching are effective in driving change in patient outcomes.
What advice would you give other Mount Sinai nurses who are thinking of starting a similar project or submitting an abstract?
Mount Sinai nurses who want to start a project must be passionate about their topic to sustain their effort through the intervention period and beyond. Getting other people involved is difficult if your project does not add value for them, so you need to offer something to generate “buy-in” from all the stakeholders involved. In addition, you need to have a clinical mentor who cares about the outcome of your project, and you have to take advantage of the resources available at Mount Sinai, such as the Nursing Project Approval Council at the Center for Nursing Research and Innovation.