decreasing healthcare costs, education, ideas, neurology, nursing, stroke



  1. Wolber, Nicole
  2. Paletz, Laurie
  3. Robertson, Betty
  4. Steiner, Nili
  5. Nezhad, Mani
  6. Guerra, Sonia


ABSTRACT: A collaborative approach was used to ascertain an appropriate stimulus for the patients to remember their stroke-specific education. The stroke education had to stand out amidst the myriad of papers and folders patients are bombarded with in the hospital. The team came up with the simple idea of using a bright red folder. When the patients were called, the call center would prompt the patient by saying, "The stroke education was given to you in a bright red folder." Before the implementation of the red folders, only 81.5% of the patients remembered receiving stroke education. After the implementation of the red folders, 96.8% remembered receiving stroke education. The principle of Occam's razor proved to be correct in our study. A very simple idea such as changing the color of the folders to bright red proved to have very meaningful results.


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Patients stay healthier when they stay informed, which makes communication key to better outcomes. Patient education is defined as a set of planned educational activities designed to improve patients' health behaviors and health status. An informed and educated patient can actively participate in his/her own treatment, improve outcomes, and often reduce his/her length of stay. We call each patient 30 days after discharge to evaluate how they are doing. We found that many patients reported either not receiving stroke education or could not remember whether they had received it. The principle of Occam's razor tells us, "The simplest idea is usually the best idea."1 We used this principle to solve our problem.


Walk into any hospital unit and you are immediately bombarded with beeping alarms of all different tones, an obstacle course of computers on wheels, and a sea of staff in scrubs and white coats. Stay at the hospital for an extended period and your "team" of doctors, nurses, specialists, and consultants grows exponentially; we all start to look the same. Each member leaves a business card or perhaps a packet of "very important" information on their way out. In no time, it seems the patient will need an administrative assistant to keep track of it all.


Cedars Sinai stroke nurses provide extensive and personalized stroke education for every patient and/or appropriate family member admitted to our unit. Patient education is defined as personalized teaching activities designed to improve health behaviors and health status. It has been shown that an informed and educated patient can more effectively participate in his/her own treatment, improve outcomes, reduce length of stay, mitigate personal risk factors, and significantly decrease the risk of having another stroke and hospital readmission.2


We make a follow-up call to each patient postdischarge to evaluate how they are doing and to see whether they received adequate stroke education and information. Unfortunately, many patients were reporting that they had never received education or they were uncertain. They were often not clear about whom they saw, who said what, or what information they received. The process was examined to uncover the disconnect between the education being delivered and how that education was received.


Various strategies were tried to prompt patient memory during our postdischarge calls-to no avail. One afternoon, during a team brainstorming session, one of our residents said, "What if we make our folder bright red?" There was initially a bit of laughter at this somewhat juvenile and overly simple idea; nevertheless, when I went home that night, I thought of the principle of Occam's razor, "The simplest idea is the best idea."


In healthcare, we sometimes think of complicated solutions to fairly simple problems. For example, "Let's add another colored banner to the electronic medical record (EMR)!", "What about an alarm," and so on. After a while, the EMR is overwhelmed with a rainbow of colorful banners; and every room, a cacophony of sounds and beeps. Alarm fatigue is a phenomenon that healthcare providers understand. Frequent alarms can lead to inadequate responses from staff because they stop hearing them after a while, which can ultimately impact patient safety.3 It seemed that the same thing was happening to our patients. They received piles of information in white folders, and it all looked the same. They just stopped paying attention. Maybe using bright red folders for stroke information was not such a crazy idea after all.


The market was scoured for the brightest of bright red folders, and an order was placed for new stroke packets. The results of this simple change were astounding. Before the implementation of the red folders, only 81.5% of the patients could recall receiving the stroke education. After the first month of using the red folders, 96.8% of the patients clearly recalled stroke education. This number steadily increased and is now close to 100% every month. It turns out we had not missed an important educational opportunity; we had only gotten lost in the ever growing pile of information a patient receives.


Healthcare costs are mounting, and there is a relentless push to decrease costs. All healthcare providers are encouraged to look outside the box when searching for solutions. Ask yourself whether you are complicating an already complicated system by the new idea you are ready to implement. Will it cause more work for staff? Will it stand out among all the other things people are doing? Is it the simplest, least expensive solution? Nurses should be encouraged to start with the principle of Occam's razor; your simplest idea to fix a problem may be the one that has a profound impact and stands out among the rest!




1. Domingos P. The role of Occam's razor in knowledge discovery. PhD University of Washington; n.d. Retrieved from http://web.cs.iastate.edy/~honavar/occam.pdf[Context Link]


2. Koelling T, Johnson ML, Cody RJ, Aaronson KD. Discharge education improves clinical outcomes in patients with chronic heart failure. Circulation. 2005;111(2):179-185. [Context Link]


3. Wilken M, Huske-Kraus D, Klausen A, Koch C, Schlauch W, Rohrig R. Alarm fatigue: causes and effects. Stud Health Technol Inform. 2017;243:107-111. [Context Link]