November 2012

E-education for TJR: Emails help manage patient expectations

In the moment: OA #3774291

By Emily Delzell

An email-based education and communication service is helping patients understand what to expect as they get ready to undergo or recover from total joint replacement (TJR) surgery.

“Education is great big satisfier for patients,” said orthopedic clinician Nancy Sevier, RN, ONC. Sevier has been working with TJR patients for 30 years, most recently at Boston’s New England Baptist Hospital (NEBH), where she and orthopedic surgeon Richard Scott, MD, partnered with electronic communication company UbiCare to develop an email series timed to coincide with a patient’s journey through the TJR process.

Along with the traditional TJR class that hospitals have been offering for decades, patients at NEBH can sign up for the 22- email series, which can start as early as 12 weeks before surgery, comes to inboxes once a week until one month postsurgery, and then is delivered once a month until six months after surgery.

“The content of the patient’s weekly emails is synched with the surgery date,” Sevier explained. “For example, a couple of days before surgery they’ll get an email that reminds them to eat lightly a few hours before the procedure or to remember to bring a photo ID to the hospital. These small but important reminders can help ease patients’ anxieties and help them remember what to expect every step of the way.”

In addition to the timed advice or reminder, each email contains a teaching point—for example, an explanation of the risk of a TJR-associated blood clot and which exercises can reduce that risk, along with a Q&A, a recent study on TJR, and an online resource.

“I had a patient tell me recently that she’d been feeling depressed about what she perceived as a lack of timely progress [after surgery]. She told me she was thinking, ‘I should be further along right now and feeling more normal,’” said Sevier. “And then she got an email that said, ‘You may be feeling a little bit down because there may still be things that you can’t do that you expected to do at this point; please remember that this is normal and look ahead to when you will be doing them.’”

This particular email is timed to come several weeks after surgery, when it’s very common for patients to feel frustrated, said Sevier.

“The information is designed to be a quick burst of exactly what you need to know when you need it, so it’s high value and efficient,” said Betsy Weaver, EdD, CEO and president of UbiCare, which is headquartered in Boston. UbiCare and NEBH launched the TJR email series in 2009, and about a dozen US hospitals now use it to reach out to their joint replacement patients. The TJR email series is one of the company’s UbiMail products, which also includes email series on spinal surgery, expectant and new family education, heart health, and others.

About 40% of TJR patients at NEBH sign up for the email series, and satisfaction among participants is high, according a survey ending November 5. Of the 1054 responders (out of a possible 4276) 86% said the email program would be a factor in their recommending the hospital to friends and family; 82% said the information was “extremely or “very” timely; and 88% said the emails were “extremely” or “very” helpful in preparing for surgery or rehabilitation.

More than 200 hospitals are now using UbiMail, said Weaver, who noted the success of the system at NEBH and other centers lies in using email to provide rigorously reviewed evidence-based information that is continuously updated along with advances in the area of interest.

“Practitioners often would like to be more in touch with their patients, but time doesn’t allow that. This system connects them, making it possible to improve behavior, improve care, and to do all that in a much less costly way in terms of human resources, time, and money,” she said.

Weaver also said that while some providers might think TJR patients tend to belong to an older, less-wired generation, the most recent statistics suggest otherwise.

“In 2012 the Pew Research Center reported that 65-year-olds and older ‘tipped’ for the first time—more than 50% are wired now. And 98% of their adult children who assist them with healthcare decisions are wired,” she said.

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