Exercise as a Vital Sign supports members in being physically active, regardless of their age or level of physical fitness. It recognizes the critical importance of regular aerobic activity to the health of all members---and uses our EHR to help turn that knowledge into consistent action.
How Often Should You Ask About Exercise
When Kaiser Permanente Southern California started our EVS program in 2009, we encouraged our staff to ask every patient at every visit about their exercise status. Recently we changed that workflow because it was getting annoying to our frequent fliers who often commented "I just told you I exercise last week, doesn't your computer keep track?" and we needed to find a way to build some efficiency back in to the patient intake process. Now, our Proactive Care Checklist will alert our front line staff in EVERY department WHEN it is time to ask and update the patient exercise vital signs. For our Chronic Condition registry patient's, we update their exercise status every 30 days and for our normal risk patient's, we update their status every 4 months. While patient's have been pleasantly surprised to hear us ask about exercise as a vital sign, reducing the frequency of how often we ask patient's coming in on a frequent basis has been a huge patient satisfier and has saved our frontline staff a few clicks from their workflow.
What Does That Workflow Look Like
The medical assistant will bring the patient back and review the Proactive Care Checklist to see if exercise vitals are due. If the checklist indicates it is time to update the exercise vitals, the support staff will take the patient's blood pressure, pulse, height/weight, temp, and then ask about physical activity levels. It's important to note that EVERY little bit counts.
Was it Difficult To Implement EVS
Getting our staff to ask about Exercise was definitely a struggle in the beginning. Not because they didn't think it was the right thing to do or because it was hard to document in our EHR, but because many of them were not exercising themselves. Having to ask someone about their physical activity level when you are overweight and inactive isn't an easy thing to do. Heck... I used to lie to my doctor's nurse about exercising because I felt guilty. How can the Proactive Care leader not take care of herself? When Kaiser took a more active stance around exercise and created activities to encourage us as employees and KP Members to take care of ourselves as well, people started to throw on their sneakers and move. As our own staff started thriving, the question became easier. I, myself, lace up my shoes as often as possible and hit pavement or the gym and my health has improved significantly because of it.
Tips for Adoption
- Consider the frequency for how often you are going to ask about exercise. Should it be at every visit if you are seeing patient's more frequently? What is the right balance between capturing information to improve clinical outcomes and not bugging the patient too much?
- Think about giving your staff talking points on how to ask the question or answer questions from the patient. Some of our staff members commented that it would have been easier for them if they would have known how to respond to questions about why we ask about exercise.
- Be prepared to define what constitutes as exercise. Walking Counts!
- Encourage your staff to be healthy as well. They need to be able to walk the talk.
What are you doing still reading this??? Get out there and get some exercise!
We are diligently working on implementation in Georgia (www.kp.org/georgia)
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