Improving Patient Satisfaction (HCAHPS) With Technology

IMPROVING PATIENT SATISFACTION

A Series of Workflows

Beyond clinical excellence, how do you provide a positive patient experience?

Why does it matter?

PATIENT SATISFACTION

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

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

Transport

Housekeeping

Bed Management Physicians

Nurses

1) Give patients a fast, smooth admittance process

ADMITTANCE

PATIENT ADMIT - PHYSICIAN COMMUNICATIONS

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

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 AdmitPatient ID: 1234567Patient Name: Michael TobinLocation: Room 532

Admitting Physician:Gloria Mendes, MD

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 AdmitPatient ID: 1234567Patient Name: Michael TobinLocation: Room 532

Admitting Physician:Gloria Mendes, MD

Radiology Results

2) Communicate test results promptly

Lab Results

Critical

Non-critical

INFORMATION SHARING

WHY ARE TEST RESULTS DELAYED?

Notifications are largely a manual processes

• Phone tag – voice mails, faxes, etc.

• Manually track notifications

• Manual data entry


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


CRITICAL TEST RESULTS

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

• 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 CenterSumter, 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

3) Respond quickly to the patient

Glass of water

Pain medication

Go for a walk

IV Is beeping

Short of breath

PATIENT REQUESTS




When able, the nurse goesto patient’s room

Staff begins to trackdown the nurse

Patient presses nurse call button

Request goes to nursing station

Nurse follows up with appropriate action

NURSE CALL REQUEST

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

Two-way communication between nurse and patient, with escalation rules and an audit trail

Lake Norman Regional Medical CenterMooresville, 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 BissonnetteDirector of Information Systems at Lake Norman

PATIENT REQUESTS

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

Code Calls

Physician-to-physician

Nursing staff

COORDINATING PROVIDER COMMUNICATIONS

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

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

• 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 HospitalGoshen, 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, BSNDirector of Cardiovascular Services

SPEEDING CRITICAL TEST RESULTS

5) Promote a quieter, more restful healing environment

Silence squeaky wheels

Promote inside voices

Reduce overhead pages

Less hallway conversation

QUIET TIME




Nurse calls for other staff nearby to assist

Nurse hears the alarm and runs to patient room—realizes it’s a

V-fib alarmPatient monitor alarm goes off

Care team runs to patient room to begins defibrillation

PATIENT ALARM - V-FIB ALARM

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 alertRoom 203

Routes all nurse call requests and patient monitoring equipment alarms and alerts to the right individual’s mobile device

Maple Grove HospitalMaple 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 WolgemuthSenior IT Project Manager at Maple Grove Hospital

QUIET TIME

PATIENT’S FAMILY

6) Keep the patient’s family updated

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.

7) Speed the discharge process

Nursing

Transport

Housekeeping

Infection Control

Pharmacy

DISCHARGE



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

Nurse messages attending physician for instructions

Attending looks up and messages specialist to get discharge

approvalPatient is ready to be discharged

WITH


Thx!

OK to discharge Jane Smith in 421?

Fine by me

Tuomey Regional Medical CenterSumter, SC

“During the three months immediately following implementation, we saw an 11% improvement in patient discharge times.”

- José Bennett

PACS Administrator


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

[email protected]

for more information

Improving Patient Satisfaction (HCAHPS) With Technology

Health & Medicine

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