When HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores for the inpatient unit on the University Campus fourth floor were presented last fall to Timothy Emhoff, MD, Chief of Trauma Surgery and Surgical Critical Care, they were not good. But they also were not a big surprise.
“We have seriously injured patients who are in a very stressful situation and sometimes aren’t entirely cognizant,” Dr. Emhoff noted, “and we also have very large teams of providers coming in and out of their rooms to care for them. It can be a difficult experience for patients and their families.”
Given the size of the care team—an attending physician, three residents, a nurse practitioner (NP), and sometimes one or two medical students, as well as floor nurses, patient care attendants and others—patients sometimes had difficulty understanding their care plan or who was in charge of it. In addition, because trauma staff are frequently activated to the Emergency Department to care for newly arriving cases, a patient may see only some of the caregivers he or she saw the day before. Communication was a challenge, and it showed in the HCAHPS scores.
But instead of blaming the low scores on the nature of life-and-death trauma care for severely injured and disoriented patients, Dr. Emhoff and his colleagues sought to change things. “Nobody threw up their hands and said, ‘Well, that’s just how it is in trauma.’ Everyone saw an opportunity to create a new model of care and communication to give our patients a better experience.”
Led by Dr. Emhoff and nurse practitioners Lisa McNamara, Cindybeth Palmgren and Jen Osborne, the fourth floor implemented regular rounding that focuses on communication and reinforcing for the patient who their caregivers are and what is happening.
The team begins rounding together each morning around 7 am, checking on each patient and explaining what their care plan is for the day. The attending physician also visits the patient and family to review the plan and assess how much they understand from the resident and NP.
To help facilitate communication:
- Dry erase boards were installed in each patient room.
- Caregivers names and roles are clearly marked on the dry erase board for each shift
- The day’s care plan is outlined on the dry erase board
- Physicians give patients their business card and explain their role.
- Patients are asked more “survey-like” questions—Have we explained everything in a way you understand? Is your pain being managed? Do you understand what will happen today and why? Do you have any questions?—to help ensure good continual communication
Also critical to the new model is the involvement of both the floor nurses and the resource nurses. In a change implemented by the nurse practitioners, led by Lisa McNamara, the rounding team now meets with the resource nurse, case manager and social worker to review each patient’s care plan and to ensure the floor nurses are well informed and can further strengthen communication with the patient. “There’s a better connection between the nurses and physicians as a team, and with the patients, too,” said McNamara.
Dr. Emhoff is confident the HCAHPS scores are improving. Anecdotally, “we hear more compliments now. It’s encouraging.” Continual feedback is important for motivation and for continuing to strategize how to best care for patients.
I love this story because of the way the team used the four-step improvement process to create a better experience for our patients: 1) Measure the results that are most important to you (patient satisfaction); 2) be transparent about and own the results; 3) standardize your process (dry erase boards, etc), and: 4) continuously re-assess your results and improve your standard work using the plan-do-study-act (PDSA) cycle.
As part of our commitment to transparency, I would like to share our most recent HCAHPS results by floor at the Medical Center.
If you have an improvement success story you would like to share, please send me an e-mail and we will try and get it posted on the blog.
Thanks for everything you do to take great care of our patients and one another,