Improving Patient Satisfaction (HCAHPS) With Technology
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The document outlines strategies to improve patient satisfaction in hospitals through effective communication and workflow enhancements. It details six key strategies: streamlining admission processes, promptly communicating test results, responding quickly to patient requests, coordinating communications between providers, promoting a quieter healing environment, and expediting discharge procedures. Successful implementations at various hospitals demonstrate significant improvements in patient care and operational efficiency, such as faster discharge times and reduced response times for critical alerts.
Improving Patient Satisfaction (HCAHPS) With Technology
- 1. IMPROVING PATIENT SATISFACTION A Series of Workflows
- 2. Beyond clinical excellence, how do you provide a positive patient experience? Why does it matter? PATIENT SATISFACTION
- 3. PATIENT SATISFACTION • Hospitals have been tracking it for years – Avatar, Press Ganey, HealthStream, etc. • Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) – Implemented 2006, reporting started 2008 – Now HCAHPS scores used in Hospital Value- Based Purchasing program – 10 questions specifically target communications
- 4. 1) Give patients a fast, smooth admittance process 2) Communicate test results promptly 3) Respond quickly to the patient 4) Coordinate provider communication 5) Promote a quieter, more restful healing environment 6) Keep the patient’s family updated 7) Speed the discharge process SIX STRATEGIES TO IMPROVE PATIENT SATISFACTION
- 5. Transport Housekeeping Bed Management Physicians Nurses 1) Give patients a fast, smooth admittance process ADMITTANCE
- 6. PATIENT ADMIT - PHYSICIAN COMMUNICATIONS COMMUNICATION BREAKDOWN COMMUNICATION BREAKDOWN TRADITIONAL WORKFLOW Physician is unavailable Patient waits in ED ED physician and attending physician need to discuss patient’s case Nurse asks operator to page attending physician Admissions staff updates ADT system ED physician and attending physician finally discuss case
- 7. PATIENT ADMIT - PHYSICIAN COMMUNICATIONS Admit notification is sent to the attending physician’s smartphone Admissions staff updates ADT system Attending physician presses number in message to connect with ED physician Attending physician gathers information from the ED physician and is now ready to visit patient WITH Patient Admit Patient ID: 1234567 Patient Name: Michael Tobin Location: Room 532 Admitting Physician: Gloria Mendes, MD
- 8. PATIENT ADMIT - NURSE COMMUNICATIONS System logs message receipt and acceptance Nurse acknowledges messagePatient is admitted and nurse is notified on smartphone Nurse completes assessment WITH Patient Admit Patient ID: 1234567 Patient Name: Michael Tobin Location: Room 532 Admitting Physician: Gloria Mendes, MD
- 9. Radiology Results 2) Communicate test results promptly Lab Results Critical Non-critical INFORMATION SHARING
- 10. WHY ARE TEST RESULTS DELAYED? Notifications are largely a manual processes • Phone tag – voice mails, faxes, etc. • Manually track notifications • Manual data entry
- 11. TRADITIONAL WORKFLOW After some phone tag, Radiologist speaks with the ordering physician about the patient Results are critical Radiology tech attempts to contact ordering physician Physician recommends patient has chest x-ray Treatment begins COMMUNICATION BREAKDOWN CRITICAL TEST RESULTS
- 12. WITH Results are sent immediately to the physician’s device and includes audit trail Results are critical The patient’s physician must be notified Physician recommends patient has chest x-ray Attending physician takes immediate action Results are entered into Spok CRITICAL TEST RESULTS
- 13. •Improved patient care and sped treatment and discharge with faster communication of test results and incidental findings •Reduced time physicians wasted calling around for test results or clarifications •Developed a communications audit trail ready for Joint Commission visits Tuomey Regional Medical Center Sumter, SC “During the three months immediately following implementation, we saw an 11% improvement in patient discharge times.” - José Bennett PACS Administrator SPEEDING CRITICAL TEST RESULTS
- 14. 3) Respond quickly to the patient Glass of water Pain medication Go for a walk IV Is beeping Short of breath PATIENT REQUESTS
- 15. COMMUNICATION BREAKDOWN COMMUNICATION BREAKDOWN TRADITIONAL WORKFLOW When able, the nurse goes to patient’s room Staff begins to track down the nurse Patient presses nurse call button Request goes to nursing station Nurse follows up with appropriate action NURSE CALL REQUEST
- 16. Nurse messages attending physician for instructions Nurse calls patient to determine need (pain) Patient presses nurse call button. Notification is automatically sent to nurse’s smartphone with patient’s room number. Patient receives medication quickly WITH NURSE CALL REQUEST Nurse Call Request: 7523 Thx! Ms Avery 523 requesting more pain control I’ll enter an order
- 17. Two-way communication between nurse and patient, with escalation rules and an audit trail Lake Norman Regional Medical Center Mooresville, NC "We wanted to improve nurse responsiveness. It was one category on patient surveys that repeatedly showed an opportunity for increased satisfaction, but we didn’t want to add complexity to a nurse’s day.” - Brian Bissonnette Director of Information Systems at Lake Norman PATIENT REQUESTS
- 18. 4) Coordinate Provider Communication “U.S. hospitals waste more than $12 billion annually from communication inefficiencies among care providers.” - Agarwal, R., Sands, D.Z., Schneider, J.D. (2010) Quantifying the economic impact of communication inefficiencies in U.S. hospitals. Journal of Healthcare Management, 55(4), 265-82 PROVIDERS
- 19. Code Calls Physician-to-physician Nursing staff COORDINATING PROVIDER COMMUNICATIONS
- 20. BEFORE SPOK Manual Paging Manual Phone Tree Wasted Time Unconfirmed Responses BEFORE Spok e.NOTIFY = 129 MINUTES TIME TO COMPLETE THE PROCESS: START RESPONSE TEAM • Cath lab staff • House supervisor • ICU shift coordinator/nurses • Attending cardiologist • Cardiovascular coordinator • ER director • Cardiovascular director • ER shift coordinator • X-ray/imaging technicians • Lab technicians Heart Attack Balloon Successful Over communicate to ensure proper response Inefficient phone trees among 30 people
- 21. THE CODE STEMI ALERT: WITH SPOK Heart Attack Balloon SuccessfulStaff Respond w/Availability Use Spok e.Notify to Deploy Code Spok e.Notify Manages Response & Escalation RESPONSE TEAM • Cath lab staff • House supervisor • ICU shift coordinator/nurses • Attending cardiologist • Cardiovascular coordinator • ER director • Cardiovascular director • ER shift coordinator • X-ray/imaging technicians • Lab technicians Spok e.Notify • Logic for on-call calendar • Auto escalations based on responses or non responses from staff • Eliminates manual calling trees and messy escalations BEFORE Spok e.NOTIFY = 129 MINUTES TIME TO COMPLETE THE PROCESS: START WITH Spok e.NOTIFY: 68 MINUTES
- 22. •Streamlining their average door-to-balloon time for heart attack patients •Reduced average door-to-balloon time from 129 minutes to 68 minutes IU Health Goshen Hospital Goshen, Indiana “For code STEMIs, there were a multitude of calls being made that didn’t need to be. It all just happens now.” - Andrea Daniels, RN, BSN Director of Cardiovascular Services SPEEDING CRITICAL TEST RESULTS
- 23. 5) Promote a quieter, more restful healing environment Silence squeaky wheels Promote inside voices Reduce overhead pages Less hallway conversation QUIET TIME
- 24. COMMUNICATION BREAKDOWN COMMUNICATION BREAKDOWN TRADITIONAL WORKFLOW Nurse calls for other staff nearby to assist Nurse hears the alarm and runs to patient room—realizes it’s a V-fib alarm Patient monitor alarm goes off Care team runs to patient room to begins defibrillation PATIENT ALARM - V-FIB ALARM
- 25. Nurse and team arrive in patient room quickly and begin defibrillation Nurse receives urgent priority V-fib alarm on smartphone and calls for staff assistance on the way to patient room Patient monitor V-fib alarm goes off WITH PATIENT ALARM - V-FIB ALARM Urgent: V-Fib alert Room 203
- 26. Routes all nurse call requests and patient monitoring equipment alarms and alerts to the right individual’s mobile device Maple Grove Hospital Maple Grove, MN "One of the significant effects of this approach, and one of the most frequent patient comments we receive, is how noticeably quiet the hospital is.” - Craig Wolgemuth Senior IT Project Manager at Maple Grove Hospital QUIET TIME
- 27. PATIENT’S FAMILY 6) Keep the patient’s family updated
- 28. PATIENT’S FAMILY “She’s out of the OR and into a room…” Family members given iPad in waiting room, loaded with messaging app. Can browse the web, check email, and be notified of status changes for their loved ones.
- 29. 7) Speed the discharge process Nursing Transport Housekeeping Infection Control Pharmacy DISCHARGE
- 30. COMMUNICATION BREAKDOWN TRADITIONAL WORKFLOW Nurse has to track down the specialist indicated by the attending for approval Attending physician writes note stating “OK to discharge pending approval from…” Patient is ready to be discharged Patient waits until approval is received, and is eventually discharged SPEEDING PATIENT DISCHARGE
- 31. Nurse messages attending physician for instructions Attending looks up and messages specialist to get discharge approval Patient is ready to be discharged WITH SPEEDING PATIENT DISCHARGE Thx! OK to discharge Jane Smith in 421? Fine by me
- 32. Tuomey Regional Medical Center Sumter, SC “During the three months immediately following implementation, we saw an 11% improvement in patient discharge times.” - José Bennett PACS Administrator SPEEDING PATIENT DISCHARGE
- 33. SUMMARY Coordinate staff required for patient admissions and discharge with automated messaging Route nurse call requests, patient monitoring equipment alarms, and alerts to the right individual’s mobile device Automatically notify ordering providers when test results are ready Reduce noise with secure texting and mobile clinical alerts
Editor's Notes
- #3: -Patients can receive exceptionally high-quality care, yet still be dissatisfied, largely because of their interaction with providers and how they perceive staff are communicating (or not) -Patient Satisfaction is a really broad topic and can include everything from concierge services and upscale meals to bedside haircuts. This presentation focuses primarily on communication, and starts with the question – Why does patient satisfaction matter?
- #4: Whether due to competition in the community or simply the general practice of the organization, hospitals have been tracking patient satisfaction for years. It has gained momentum and focus, especially in the last decade, because now there are very direct financial incentives behind the scores. Back in 2002, Centers for Medicare & Medicaid Services (CMS) partnered with the Agency for Healthcare Research and Quality (AHRQ), to develop and test the HCAHPS Survey to create a publicly reported, standardized survey, really allowing an apples-to-apples comparison between facilities for consumers. There are also financial incentives for facilities in the IPPS program (Inpatient Prospective Payment System), HCAHPS scores are now used in calculating payments in the Hospital Value-Based Purchasing program
- #5: Here are several of the pain points top hospitals are focused on, and in our presentation we’ll cover some approaches and tactics to address them
- #6: Whether a patient has a scheduled hospital visit or they arrived an unexpectedly in the ED, once they know they’re being admitted, waiting to get to the room can seem to take an eternity. Holdups are often caused by inefficient communications among all of staff members and departments involved in the process. THE CHALLENGE: is to ensure information gets where it needs to go quickly and easily, reducing wasted time in the process
- #8: So now let’s look at Spok’s take at this process… READ SLIDE The patient comes into the ED and needs to be admitted for additional diagnostic testing An admit notification is automatically sent to the attending’s smartphone, and the message has info on the patient and the admitting Within the message there’s a link the attending can use to connect with the admitting physician for a quick consult - notice that the nurse is taken our of the equation here After this consult the attending is ready to visit with the patient So to be clear - what we’re looking at here are several technologies working together with Spok: We have an integration to the ADT system to capture admit events… We have an encrypted smartphone messaging application, which captures all activity in an audit trail for every interaction… And we also have a tool for caregivers to indicate their preferred method of contact based on time of day, priority of the message, and so forth.
- #10: Waiting for test results is another common source of frustration for patients. That wait can be simply annoying if the patient receives negative results and ultimately gets sent home. On the other end of the spectrum, a delay in results that indicate a life-threatening situation can directly impact patient care. The Joint Commission analyzes sentinel event data reported in the U.S. each year, and while communications is among the top three root causes for all event types, looking specifically at sentinel events resulting from delay in treatment, communication is consistently the number 1 root cause.
- #11: The CHALLENGE – eliminate the wasted time – phone calls, documentation
- #13: So what we’re able to do here is to take the responsibility for contacting the physician out of the Radiologist’s hands, and automate that process We’re also able to make the physician’s life easier by delivering the details of the findings in text format (encrypted of course). All this is saved and recorded as part of an audit trail. And one point that’s also worth noting - if this were a normal result (as opposed to critical) getting this detail to the physician helps speed the process and get the patient discharged quicker.
- #14: Tuomey Healthcare in South Carolina is an excellent case study for this workflow Spok has worked with Tuomey to integrate our Critical Test Results technology with their Healthcare Information System, Radiology Information System, and their Picture Archiving System Tuomey is a great example because not only did they see a time savings in their process of communicating with the doctor, they also reported an 11% improvement in discharge times because non-critical results were being reported more efficiently, letting the doctor know that no additional treatment was needed for that patient.
- #15: Of the hospital-related questions on the HCAHPS survey, two specifically ask about staff responsiveness to calls for assistance The CHALLENGE: Managing the nurse-call system to route requests efficiently (because hospital staff are largely are a mobile bunch), and to the correct care provider. For example, a request for pain medication would be routed to the nurse, while perhaps the nursing tech can bring a glass of water or assist a patient walking around the floor. For respiratory or other distress, a rapid response team might be most appropriate
- #17: Since the Spok app integrates with the hospital’s directory, the nurse can quickly and easily look up the nursing tech from her smartphone, send a message, and then receive a reply back from the nursing tech. Once the nurse receives confirmation she knows that the nursing tech is on their way to help the patient and the nurse is able to care for another patient.
- #18: Spok has worked with Lake Norman Regional Medical Center to implement two-way communication between nurse and patient, as described a moment ago. This is something which was put in place as a direct response to the hospital’s patient surveys, which indicated an opportunity to improve satisfaction
- #19: Like improving the admissions process, coordinating provider communication is an indirect method of enhancing the patient experience and focuses on the clinical avenues for improving outcomes. While patient satisfaction scores may not always directly correlate to quality of care, quality certainly still makes a big difference. And besides reduced reimbursements from poor patient survey scores, uncoordinated care can also be quite expensive in a more direct way. (reveal Quote) Of that amount, increased length of stay accounts for 53 percent. Looking more closely at what poor communications cost an individual facility, the authors estimate a 500-bed hospital loses more than $4 million per year. The article’s concluding remarks mention that, “Information technologies and process redesign may help alleviate some of this burden.”
- #20: THE CHALLENGE: being able to reach other staff members – either needing their numbers, or the staffing schedules, on-call schedules, etc. With Code calls the challenges are also scheduling, plus needing to track responses and ensure people are responding. Gerard will give us a closer look at a specific code call and solution.
- #23: Spok worked with Goshen Hospital to address their door-to-balloon time, which at one time was averaging 129 minutes (well above the 90 minute mandate) With the automation in place, Goshen was able to reduce their response time to 68 minutes, nearly cutting response time in half.
- #24: Research has shown how important sleep is to mental and physical health, and that a peaceful environment is important to the healing process. Patients struggle with disturbances in hospitals every day, from overhead announcements, hallway conversations, and infuser pump alarms, etc. Noise not only disrupts patient healing, it is also a common source of dissatisfaction. A January 2012 study by University of Chicago researchers found that hospital noise levels often exceeded World Health Organization recommendations. And a June 2012 study by Harvard University researchers found that patients' heart rates increased after noise-related sleep disruptions. THE CHALLENGE: Reduce noise, from staff, visitors, and the general functioning of the hospital Several low-tech initiatives include keeping all cart wheels silent, using gentle music on the overhead paging system to signal the start of quiet time at night, and posting signs on all patient floors reminding visitors to use inside voices. Some leading hospitals are also pursuing technology solutions to help foster a quieter environment by reducing overhead pages and phone conversations in the hallway
- #25: If we examine this process, we can see two steps in which improvements can be made; we see two breakdowns in communications: The nurse hears alarm but must take the time to run to the patient room and learn which alarm it is Truly an issue of patient safety
- #26: Here’s how Spok can improve the situation With alarm management software, the nurse can immediately see that is a V-fib alarm. She does not have to run into patient room to learn what it is and run back out for assistance. She can yell for trauma team on her way to the patient room because she is already aware that it is a V-fib alarm.
- #27: Maple Grove Hospital has a nice success story working with Amcom The customer reported a far more quiet hospital after routing all nurse calls and patient monitoring alarms to mobile devices That’s a lot less overhead announcements, and a lot less beeping and buzzing from around the hospital
- #28: Families are another important consideration for patient satisfaction because how they talk about their experience at the hospital with their loved one can influence your patient’s perceptions when it comes time to fill out the survey. One of the most stressful times for families is waiting fo rnews when a loved one is in the operating room.
- #30: And last, we come full circle to the end of the journey with number 7 being to speed the discharge process. Very similar to number 1 and speeding admissions, patient discharge also involves coordinate a team of staff. THE CHALLENGE: is to ensure the patient can go home shortly after being notified that they are ready for discharge and not have to wait for three hours after getting dressed This involves some of the same teams, nursing staff, transport, housekeeping, it can also involve other departments such as infection control and the pharmacy. Here, as with admissions, one solution is to use technology that enables secure messaging to mobile devices. But that’s not all – (Gerard take over with next slide)
- #33: Again, we’ll use Tuomey Healthcare as the example here - because this customer was able to improve the process of reporting both critical and non-critical results, they saw an 11% improvement in patient discharge times.