Improving HCAHPS in a Challenging Patient Population: Trauma and Burns

Introduction

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a metric that represents the patient’s perception of quality care received. Data supports that the patient’s experience is linked to great clinical care, reduced medical error, and improved patient outcomes. HCAHPS is part of the value- based purchasing initiative that ties reimbursement to quality outcomes.  Each individual patient’s survey results matters.  These questions measure frequency on a scale of never, sometimes, usually, and always. Three of the six categories of HCAHPS questions relate to communication: with doctors, with nurses, and about medications.  The purpose of this presentation is to describe the development and implementation of a standardized orientation process for trauma and burn patients and its impact on the HCAHPS composites related to communication. 

Methods

In an effort to increase the HCAHPS categories related to communication, a standardized orientation was created. A multidisciplinary team was formed including key stakeholders from the Trauma and Burn Intensive Care Unit (TBICU), Neuro Intensive Care Unit (NICU), Emergency Department (ED), Acute Care Trauma Unit, and the Trauma and Burn Unit.  A review of current literature was completed and a best practice identified.   The team decided to create a video that patients and families would view within the first 12 hours of admission.  Key talking points were identified and distributed to all frontline staff.  The team then decided to pilot the standardized orientation process on the Acute Trauma Care Unit.  Education was provided to all members of the health care team.  During this phase, documentation of the patient viewing the video with in the first 12 hours was validated.  Nurse leaders on the unit spoke to every patient in the first 24 hours of admission to answer any questions, ensure compliance with the new process, and address any concerns. Staff nurses were asked to complete a brief questionnaire about the new orientation process.  HCAHPS survey results were evaluated by discharge date during the three month pilot phase. 

Results

HCAHPS scores in the categories involving communication improved.  Nurses involved in the pilot provided positive feedback with qualitative data supporting the consistency and effectiveness of the new process. The exact process is now being utilized in several other units where burn patients receive care and other specialty areas have used the process as a guide to create unit specific orientation videos. 

Conclusions

A consistent patient and family centered orientation process, upon admission with individual one on one discussion with the bedside nurse, positively impacts the HCAHPS composites related to communication.

Applicability of Research to Practice

Success of the implementation of this initiative in practice relies on the commitment of key people within the organization to see activities through from planning to implementation and ongoing evaluation.  Involving key stakeholders in the project team, created buy in and provided support for sharing best practices throughout a large academic medical center.  Additional research could be completed to evaluate the effectiveness of a video versus a written standardized orientation.