A Quality Collaborative or HCAHPS
Kendall Regional Medical Center is a 417-bed facility in Miami-Dade County, Florida. A CMS survey revealed that Kendall has below average scores in nine HCAHPS measures, including hospital recommendation (62%). It is suggested that the hospital focuses on patient satisfaction and safety to reduce mortality rate related to heart attack, heart failure, and pneumonia. The sub-par scores is an impetus for quality initiatives to improve patient safety and satisfaction.
Kendall is working to improve HCAHPS scores and the overall rating through evidence-based initiatives that address communication and patient safety. One core HCAHPS measure that is essential for better quality performance at the hospital is improving inter-professional communication through techniques such as the SBAR tool and hourly rounding (Lyu, Wick, Housman, Freischlag, & Makary, 2013). Kendall should focus its QI efforts on improving quality performance through better patient communication and engagement. The teach-back method could be adopted to educate patients on medication instructions and their illnesses. Evidence shows that patient involvement increases patient satisfaction and safety (Lyu et al., 2013). Patient involvement also increases medication adherence, which improves the overall clinical outcomes.
Kendall score’s in hospital-acquired infections is below the national average (41%) in relation to catheter-associated UTIs. Such infections compromise patient safety and reduce the quality rating of a hospital. Some preventive practices include “hand washing and clinical protocols for indwelling catheters” to reduce the risk of infection (Lyu et al., 2013, p. 366). Another area related to patient safety is patient falls, especially among geriatric patients. Effective fall prevention programs that could be implemented in healthcare centers include fall risk assessment, tread socks, and change of medications/drugs (Lyu et al., 2013).
Another dimension of patient safety relevant to Kendall is surgical site infections. Kendall scores above national average in surgical site infections (82%). It utilizes a surgical safety checklist to avoid errors and reduce the risk of infection through antibiotic administration (Medicare.gov, 2016). Establishing a rapid response team could help reduce mortality rates. The team should include critical care professionals to offer quality bedside care.
Purpose of HCAHPS, Quality Measures, and Tools
HCAHPS offers a standardized survey tool for “measuring patients’ perspectives” on the inpatient care received (Bush, 2012, p. 13). Its main purpose is to capture data on various dimensions of inpatient experience for hospital comparisons and enhance accountability through public reporting. HCAHPS survey contains seven composite measures, two individual items, and two global items. Kendall will use five HCAHPS composites measures of nurse and physician communication, medication information, care transition, and care information to promote safe and quality care. Communication is central to safe care delivery and improved patient engagement. Evidence-based practices will be adopted to enhance communication and patient safety to increase value-based purchasing (VBP) payment incentives that are awarded to the hospital.
The Joint Commission’s key quality measures include mortality rates due to heart attack, heart failure, pneumonia, surgical care, and children’s asthma. Tracking and monitoring these quality measures indicates a hospital’s quality performance over time. Kendall performs above the national average in heart attack (14%), heart failure (12%), and pneumonia (10%). The facility should improve provider communication and care transition to increase the HCAHPS scores. Studies show that high HCAHPS scores are associated with better clinical outcomes related to “congestive heart failure, pneumonia, and surgery” (Elliott et al., 2012, p. 62). Additionally, hospital rating and recommendation are high in hospitals with improved heart failure outcomes (Elliott et al., 2012). On the other hand, improved patient-clinician communication enhances medication adherence and decreases the potential for sentinel events.
Hospitals can use different tools to promote provider communication, a key measure of inpatient experience. Providers can reinforce critical medical instructions to patients through the teach-back method, use of whiteboards, follow-up calls, and utilization of interpretation services for the non-English speakers (Fenton, Jerant, Bertakis, & Franks, 2012). Physician/nurse communication at the hospital could be improved through bedside shift-to-shift reporting and use of the SBAR tool. Improved provider communication would reduce the risk of medical errors and improves patient involvement and satisfaction.
Description of Data
HCAHPS data can be collected by the hospital or through a certified survey agency. The survey data are collected from discharged adult participants within six weeks after leaving the hospital. HCAHPS data consists of patient feedback on areas related to nursing and physician care.
Data on nurse communication must be collected to assess the quality of nursing care received. Nurse communication facilitates patient involvement in care planning and clinical decisions, which contributes to better patient experience (Girotra, Cram, & Popescu, 2012). Physician communication is an indicator of quality that improves the safety of patient care and reduces patient anxiety. Therefore, patient feedback on doctor communication must be obtained to measure the quality of physician care. Additional data will be collected on staff responsiveness, which evaluates the speed and efficiency of medical care delivery when needed; hence, it is a good process measure.
The hospital must also measure patient feedback on pain management. Effective pain control contributes to safe care and patient satisfaction. Communicating about medicines can also enhance patient safety by reducing the medical error risk and potential for sentinel events. Data must be collected on the quality of discharge information and care transition, which affect readmission rates and mortality rates of discharged patients. Additional data should be collected on individual HCAHPS items of clean room and quiet room that influence inpatient experience. Lastly, their feedback on the HCAHPS global items of hospital recommendation and rating must be collected within the reporting period.
A Comparison of the Measures with State and National Averages
A comparison of Kendall Regional Medical Center’s HCAHPS scores to the Florida and national averages on the 11 measures shows that the hospital has an overall rating of 2/5. It scores above the state average in pain management and physician communication. The hospital’s score on the ‘medication information’ measure is the same as the state average (62%).
The reported HCAHPS scores are lower than the national average in all the 11 indicators. The hospital performs below the national average in composite HCAHPS measures such as nurse communication (74% vs. 80%), doctor communication (79% vs. 82%), and staff responsiveness (60% vs. 68%). Its HCAHPS scores in medical communication, pain management, discharge information, and care transition are also below the national averages. Its performance on individual HCAHPS items of clean room and quiet room is also lower than the national average. Only 60% of the discharged patients gave the hospital a higher rating (9 or 10). In addition, only 62% of the surveyed patients could recommend the hospital to other patients as shown in table 1 below.
Table 1. HCAHPS Scores for the Hospital Compared to State and National Averages.
References
Bush, H. (2012). Action plans for better care: Hospitals are using a variety of strategies to improve the patient experience. Trustee: The Journal for Hospital Governing Boards, 65(2), 12–18.
Elliott, M., Lehrman, W., Goldstein, E., Hambarsoomian, K., Beckett, M., & Giordano, L. (2012). Do hospitals rank differently on HCAHPS for different patient subgroups? Medical Care Research and Review: MCRR, 67(1), 56–73.
Fenton, J., Jerant, A., Bertakis, K., & Franks, P. (2012). The cost of satisfaction: A national study of patient satisfaction, health care utilization, expenditures, and mortality. Archives of Internal Medicine, 172(5), 405–411.
Girotra, S., Cram, P., & Popescu, I. (2012). Patient satisfaction at America’s lowest performing hospitals. Circulation Cardiovascular Quality and Outcomes, 5(3), 365–372.
Lyu, H., Wick, E., Housman, M., Freischlag, J., & Makary, A. (2013). Patient satisfaction as a possible indicator of quality surgical care. The Journal of the American Medical Association, 148(4), 362–367.
Medicare.gov. (2016). Hospital profile: Kendal medical regional center. Web.