NURS 630 Week 8 Evidence-Based Project Part 4: Digital Poster Presentation Example

Help at the Bedside, Access for Everyone: Nurse-Led Portal Coaching to Close the Gap in Inpatient Patient Portal Use

Abstract

Since the Cures Act information blocking rule, hospitalized patients can read their notes and results in the portal in real time, but use is lower among older, Black, Hispanic, Spanish-speaking and Medicaid-insured patients. At a composite 300-bed community hospital, 38% of inpatients had an active account at admission. A synthesis of nine recent studies showed consistent disparities and suggested that supported access improves understanding, involvement and safety. A new nursing protocol introduces bedside portal coaching at admission and discharge, to be piloted on two medical-surgical units through three Plan-Do-Study-Act cycles. The primary measure is an equity ratio: the pilot aims to raise portal use during the stay from 31% to 55% of admissions while bringing use among Spanish-speaking and Medicaid patients within 10 points of the unit average, with coaching kept to ten minutes. Bedside coaching by nurses offers a practical way to make open records usable by every patient.

Knowledge Discovery

• Problem: some groups of inpatients rarely open the portal while they are in the hospital
• Local picture: 38% of adult inpatients had an active account; use lowest at age 75 and older, among Spanish speakers and among Medicaid patients
• National picture: only 31.0% of 43,588 hospitalized adults at one academic center had an active account (Cool et al., 2025)
• Framework link: QSEN informatics and patient-centered care; the CMS Promoting Interoperability provider-to-patient exchange objective

Every patient now has the right to see the record; this project asks who actually gets the help to do it.

Evidence Summary

Use Is Common but Unequal

Large cohorts in surgical, cancer and pediatric hospitals saw the portal used least by elderly patients, by Black and Hispanic patients, by Spanish speakers and by people covered through Medicaid (Bain et al., 2025; Redelman-Sidi et al., 2026).

Supported Access Helps

Patients trained at the bedside reported better communication and medication understanding (Alla et al., 2026), and parents reading notes on bedside tablets identified real safety concerns, including a medication error (Kieren et al., 2026).

The Evidence Gap

No study tested an intervention aimed at the equity gap in inpatient portal use, and none tested nurse-led coaching.

Translation, Integration and Evaluation

• Decision: no existing policy assigned anyone to help inpatients use the portal, so a new Inpatient Portal Access and Coaching Protocol was written
• Protocol: portal question in the admission database; ten minutes of coaching inside the first day, using whichever device the patient has or a loaned unit tablet, with an interpreter as needed; after-visit summary shown in the portal at discharge
• Change model: three six-week Plan-Do-Study-Act cycles on a medical unit, a surgical unit, then both
• Integration: eight unit portal champions, one advisory that fires only when coaching is overdue, two managed tablets per unit

The baseline figures come from the hospital's portal audit report for the twelve months before the pilot, and the units will see every measure each month, and the informatics council will review them each quarter. The equity rows matter most: overall use could rise while the gaps widen if coaching reaches mainly patients who were already likely to log in. Use among patients aged 75 and older, currently 14%, will be tracked separately, since older patients may need caregiver proxy setup more than personal coaching.

Implications for Future Research

• Once the pilot ends, does coaching during a stay change portal use after discharge, such as reading results and messaging the care team within 30 days?
• Would a caregiver-focused version of the protocol, centered on proxy access, close the gap for patients aged 75 and older?
• Is coached portal use associated with fewer medication discrepancies at discharge or fewer calls after discharge, when compared with matched units without coaching?

These questions would require a comparison design across several units or hospitals, which a single-site pilot could not provide. A stepped rollout across the hospital's remaining medical-surgical units, with each unit serving as its own comparison before coaching begins, would be a practical next design and would let the hospital answer the first and third questions without withholding coaching from any unit for long.

Biblical Perspective

Proverbs urges God's people to open their mouths for those who cannot speak and to plead the cause of the poor (English Standard Version Bible, 2001/2016, Proverbs 31:8-9). Access to one's own health record is now a legal right, and this project treats making that right usable for every patient as part of nursing's advocacy.

References

Alla, S., Kukreja, R., Harrison, G., Royal, S., & Markus-Rodden, M. (2026). Effect of patient portal utilization on patient experience among hospitalized adult patients on an orthopedic surgical unit. CIN: Computers, Informatics, Nursing, 44(1). https://doi.org/10.1097/CIN.0000000000001311

Bain, A. P., Heslin, R., Matthews, L., Ji, H., Moore, C. B., Higashi, R. T., Louissaint, J., McDonald, S. A., Navar, A. M., Willett, D., Steitz, B. D., & Turer, R. W. (2025). Patient portal use among admitted surgical patients following the 21st Century Cures Act. JAMA Surgery, 160(10), 1082-1090. https://doi.org/10.1001/jamasurg.2025.2799

Cool, J. A., Zhang, C., Yang, J., Herzig, S. J., & Roches, C. D. (2025). Hospitalized patient portal access in the post-information blocking rule era. Journal of Hospital Medicine, 20(12), 1290-1296. https://doi.org/10.1002/jhm.70093

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Kieren, M. Q., Lee-Miller, C., Smith, C. A., Brown, R., Limjoco, J. J., McArdle, K., Uhing, A., Veit, A., & Kelly, M. M. (2026). Parent experiences accessing inpatient clinical notes on a pediatric oncology service. Hospital Pediatrics, 16(6), 536-543. https://doi.org/10.1542/hpeds.2025-008530

Redelman-Sidi, Y., White, C., Seier, K., Lipitz-Snyderman, A., Dawson, J. P., Kuperman, G., Polubriaginof, F. C. G., & Chimonas, S. (2026). Disparities in cancer patients' portal usage during hospitalizations. Applied Clinical Informatics, 17(4), 844-853. https://doi.org/10.1055/a-2961-1034