Can patients reliably identify safe, high quality care?

Patient experience is valuable because it reflects how patients perceive the care they receive within the healthcare system and is associated with clinical outcomes. Also, as part of the Hospital Value-Based Purchasing (HVBP) program, the Center for Medicare and Medicaid Services (CMS) rewards hospitals with financial incentives for patient experience as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. It is unclear how the addition of residents and advanced practice clinicians (APCs) to hospitalist-led inpatient teams affects patient satisfaction as measured by the HCAHPS and Press Ganey survey. To compare patient satisfaction with hospitalists on resident, APC, and solo hospitalist teams measured by HCAHPS and Press Ganey physician performance domain survey results. Retrospective observational cohort study. All patients discharged from the Internal Medicine inpatient service between July 1, 2015, and July 1, 2018, who met HCAHPS survey eligibility criteria and completed a patient experience survey. HCAHPS and Press Ganey physician performance domain survey results. No differences were observed in the selection of "top box" scores on the HCAHPS physician performance domain between resident, APC, and solo hospitalist teams. Adjusted Press Ganey physician performance domain survey results demonstrated significant differences between solo hospitalist and resident teams, with solo hospitalists having higher scores in three areas: time physician spent with you (4.58 vs. 4.38, p = 0.050); physician kept you informed (4.63 vs. 4.43, p = 0.047); and physician skill (4.80 vs. 4.63, p = 0.027). Solo hospitalists were perceived to have higher physician skill in comparison with hospitalist-APC teams (4.80 vs. 4.69, p = 0.042). While Press Ganey survey results suggest that patients have greater satisfaction with physicians on solo hospitalist teams, these differences were not observed on the HCAHPS physician performance survey domain, suggesting physician team structure does not impact HVBP incentive payments by CMS.

Excellence in healthcare is a key outcome for providers and consumers of healthcare services alike. Patient satisfaction is a firmly recognized indicator of quality and patient-centeredness of a healthcare system. Beginning in 2013, healthcare organizations have been reimbursed based on their Centers for Medicare and Medicaid Services (CMS) Value-based Purchasing score, 70% of which is based on clinical outcomes of care and 30% on patient satisfaction. Higher satisfaction scores also drive a number of increased patient quality indicators and decreased malpractice litigation. The purpose of this research was to quantitatively measure the relationship between a positive professional practice environment, in this case Magnet Recognition Program® designation, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction, top-box score for the question "Would you recommend this hospital to your friends and family?" and also to triangulate nurses' perceptions within a Magnet® status organization on actions that drive higher "willingness to recommend" scores. This study was designed to determine whether significant correlations exists between Magnet Recognition Program® designated healthcare organizations and non-Magnet® healthcare organizations in terms of the "willingness to recommend" question on the HCAHPS survey. This study is a quantitative secondary analysis of data collected and compiled from the American Nurses Credentialing Center, and the CSM HCAHPS database. A qualitative study was performed using naturalistic inquiry to gather more in-depth information to clarify the quantitative data. Analysis of the data revealed that Magnet® designated organizations have significantly (p < .05) higher scores than non-Magnet designated organizations. Qualitative results revealed nursing units that scored well on the "willingness to recommend" question demonstrated a patient-centered model of care with concrete advocacy actions on behalf of patients and families, and that positive interprofessional team relationships were the most successful in driving a higher "willingness to recommend" score within a Magnet® organization. The implications of these results for nursing organizations and overall outcomes analysis are presented.

77 - The Impact of Immediate Postdischarge Complications on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey Results in a Lumbar Spine Surgery Population

Patient Satisfaction After Total Hip Arthroplasty Is Not Influenced by Reductions in Opioid Prescribing

The effectiveness of structured multidisciplinary rounding in acute care units on length of hospital stay and satisfaction of patients and staff: a systematic review protocol

Hospital Consumer Assessment of Healthcare Providers and Systems: Do Patient Demographics Affect Outcomes in Total Knee Arthroplasty?

Evaluating the effects of a high-tech call system on patient-staff communication.

Perioperative factors associated with Hospital Consumer Assessment of Healthcare Providers and Systems responses of total hip arthroplasty patients

Stroke patients need written information on how to recognize and prevent a secondary stroke. Limited health literacy is associated with medication errors and a lack of knowledge for chronic health conditions. Written communication needs to be inviting and understood by the largest population possible. At University Hospitals Comprehensive Stroke and Cerebrovascular Center (UHCSCC) the education book, “HOPE, A Stroke Recovery Guide” from the National Stroke Association has been given to patients for many years. It is 66 pages long, black and white print with very few pictures. Patients in the acute hospital setting describe it as overwhelming. The purpose of this project is to assess any impact on stroke patient satisfaction scores at UHCSCC using a new education book. Using the principles of health literacy, a group of physicians, nurses, and a pharmacist collaborated to develop a hospital branded stroke education book. Health Literacy Advisor software was used to assess readability and suggest plain language alternatives. The format was presented in chunks of information using bullet points on 21 pages and many colored pictures. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey, the national, standardized publicly reported survey of patients’ perspective on hospital care, was used to evaluate any impact of the new education material. Four questions on the HCAHPS survey were used: “How often did nurses explain things in a way you understand?” “How often did doctors explain things in a way you understand?” “Did you understand the purpose of taking your medicines? “Before giving you any new medicine, how often did the hospital staff tell you what the medicine was for?” Reviewing responses over a 12 month period, the top box percentages for all four questions increased after the introduction of the new book. Nurses’ explanations score increased 5.5%. Doctors’ explanations score increased 5.3%. Understanding purpose of medications score increased 15.2% and Explanations for a new medication score increased 2.7%. Publicly reporting of HCAHPS results creates incentives for the hospitals to improve quality of care. At UHCSCC stroke patient satisfaction scores improved with introduction of new shorter, colorful education book.

Hospitals are continuously facing pressures to mitigate the gap between patient’s expectations and the quality of services provided. Now with Medicare reimbursements tied to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, institutions are attempting interventions to increase satisfaction scores. However, a standard framework to understand patient values and perceptions and subsequently translate it into reliable measures of patient satisfaction does not exist, particularly in the inpatient settings. This article highlights opportunity for the addition of qualitative customer value research to augment the information providers gain from HCAHPS scores and provide additional indicators that can be used in improving the patient experience. In this article, patient laddering interviews and hierarchical value mapping are reviewed as methodologies to understand patient core satisfaction values during their hospital stay. A systematic literature search was performed to identify articles addressing laddering interviews and hierarchical value mapping as applied to health care. Inclusion criteria involved studies relating to health care and using laddering interviews. Exclusion criteria included non-health-care studies. Only 3 studies were found eligible for this review. Our systematic review of literature revealed only few studies which may help to guide us to improve patient experience using laddering interviews. These interviews can help compose a personalized bedside survey which may be more meaningful than current widely used HCAHPS survey.

From major to minor: Are all endoscopic complications created equal?

Patient satisfaction is a driving force for healthcare organizations to enhance patient services. As the Asian population in the United States is increasing at a significant rate, it is important to understand the needs of this population to implement culturally focused services that will lead to increased Asian in-patient satisfaction. The objective of the systematic review was to identify the best available evidence on the effectiveness of culturally focused interventions in increasing satisfaction of hospitalized adult Asian patients. This review considered studies that included Asian adults, 18 years of age and older, who were admitted to acute-care hospitals in countries where Asians are a minority culture. This review considered studies that included any intervention or sets of interventions implemented by hospitals for the purpose of making the hospital experience consistent with the cultural preferences of adult Asian in-patients. Satisfaction of adult Asian hospitalized patients as measured by self-report satisfaction scales or tools considered by accrediting and/or governing bodies to be acceptable sources of evidence of patients' perceptions of their care. This review first considered randomized controlled trials (RCTs), non-RCTs and quasi-experimental studies. As no RCTs or quasi-experimental studies were found, the reviewers also considered before and after studies, cohort studies and case-control studies for inclusion. This review also considered for inclusion descriptive study designs including case series, individual case reports and descriptive cross-sectional studies related to the adult Asian population in acute-care hospital settings. Three descriptive studies were selected in the review. The search strategy aimed to find both published and unpublished studies in English and Chinese (Mandarin and Cantonese) languages. A search of MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Educational Research Information Clearinghouse (ERIC), the Cochrane Library, the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, Scopus, Excerpta Medical Databases (Embase) and Academic Search Premier was conducted, followed by a reference search of relevant studies and a gray literature search of the Virginia Henderson Library, Google Scholar, Mednar, conference proceedings and websites. The initial key words searched were patient satisfaction, culturally focused, hospitals, Asian-American and adult. Data were extracted using a standardized critical appraisal checklist and data extraction instrument from the Joanna Briggs Institute. Due to the statistical and methodological heterogeneity between included studies, statistical meta-analysis was not possible. Results are presented in a narrative summary. Three descriptive studies were reviewed with sample sizes ranging from 107 to 19,583 and a total of 386 Asian participants. Two of the studies reported on nine measures of patient satisfaction, whereas the third provided data on four measures. The interventions identified were: communication between physician/registered nurse and patient, cultural services, Asian social workers, interpreters, and cultural food. The first study included intervention groups that were exposed to inpatient information on hospitalized Chinese cultural services compared to the "usual care" control. The percentage of patients' satisfaction in the group who knew about the services (95%) was significantly higher (p < 0.01). In the same study, patients' satisfaction with nurses was higher (95%) in patients with nurses who were aware of Chinese cultural services, compared to patients with nurses who were unaware (83%) (p < 0.01). The second study developed a survey measuring 'Level of Top Box' satisfaction of Chinese patients in Chinese unit ('Informed of Chinese Culture Service') and non-Chinese unit ('Usual Care') with the outcome measure for patient satisfaction without p value. The two studies showed an increase in Asian inpatient satisfaction with communication between the physician/registered nurse and patient, as well as with pain control and quietness of the room. Also, two studies used the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) questions as patient satisfaction surveys. The third study was a descriptive/comparative secondary analysis of HCAHPS and Cultural Competency Assessment Tool for Hospitals (CCATH) surveys. There was also no p value for patient satisfaction measurement. The design and analysis of this study was more complex, using hospital wide-cultural competency and addressing factors such as race and language ability (English and non-English speakers). The surveys completed in Chinese were less than 0.1% of the sample size and the Asian data were eliminated. This study also showed that a greater degree of cultural competence in hospitals was positively associated with patient satisfaction with doctors' communication (P < 0.05). Evidence was insufficient to demonstrate cause and effect. Results suggest that culturally competent communication with patients by physicians and registered nurses, quietness of the room, information about treatments and procedures, and cultural foods are associated with increased satisfaction among hospitalized adult Asian patients.

Objective: In today’s work environment, specifically in health care, mindfulness is a personal and professional strategy to improve performance and productivity. To influence the patient and care team hospital experience through the concepts of mindfulness and perception.Methods: This was a prospective observational project completed by medical/surgical nurses using an online survey pre- and post an educational program and an aggregate score of the 5 nurse-sensitive questions on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, a survey based in the United States that is mailed to patients post discharge to home to measure patient satisfaction with their hospitalization. The HCAHPS survey is a patient satisfaction survey required by the Centers for Medicare and Medicaid Services (CMS) for all hospitals in the United States. The purpose of the HCAHPS survey is to provide a standardized survey instrument and data collection methodology for measuring patients’ perspectives on their hospital care and hospital experience.Results: The aggregate nurse-sensitive HCAHPS scores increased from 85.5 to 89.8 over one month. For mindfulness, after the educational program, among the ten nurse survey questions the percentage went up as much as 0.57%.Conclusions: An educational program related to the benefits of mindfulness can positively effect nurses’ engagement in the workplace and positively increase HCAHPS scores. Continuing education on mindfulness should carry over month to month. In this research project, participants provided feedback to the researcher of feeling empowered to bring in new ideas, present different ways to grow, and tackle challenges.

There is widespread concern that the implementation of the Affordable Care Act will lead to increased health care spending in the United States. One commonly proposed mitigation strategy is the expansion of the scope of practice for advanced practice registered nurses (APRNs). In the November 2013 issue of Health Affairs, several authors discuss using nurse practitioners (NPs) as a way to decrease health care costs (Iglehart, 2013). This is good news. But we need more advanced practice research, especially in the area of emergency department (ED) patient outcomes. Historically, most of the patient outcomes studies with regard to emergency nurse practitioners (ENPs) have been published by ENPs in Australia, Canada, and the United Kingdom (Ducharme, Alder, Pelletier, Murray, & Tepper, 2009; Sandhu, Dale, Stallard, Crouch, & Glucksman, 2009). Only recently have ENPs from the United States offered research contributions with regard to ENPs and patient care outcomes. AUSTRALIAN STUDIES In 2006, ENPs from Australia looked at ENP care and ED patient flow (Considine, Martin, Smit, Winter, & Jenkins, 2006). This study compared ED wait times for patient assessment and management. The study also looked at length of stay (LOS) and treatment times for patients cared for by an ENP candidate as compared with the traditional ED care method with a physician. The authors concluded that there were no significant differences in wait times, LOS, and treatment times. The authors also noted that patient flow outcomes for patients seen by ENPs are comparable with those of patients managed by the physician. That same year Considine (2006) also set out to define the scope of practice of the ENP role in a metropolitan ED in Australia. In 2008, a group of researchers demonstrated shorter wait times and ED LOS associated with the use of ENPs in a major urban ED in Melbourne (Jennings, O'Reilly, Lee, Cameron, Free, & Bailey, 2008). The average wait time for emergency patients seen by the ENP was 12 min compared with 31 min for those seen by a physician. Length of stay in the ED was also significantly lower in the ENP group (94 min) than in the physician group (170 min). Wilson (2008) investigated the effectiveness of ENPs in an adult ED and assessed patient satisfaction for the care received for minor injuries. A majority of patients were satisfied with the treatment received from NPs. The authors also noted that patient flow through the department was significantly improved. CANADIAN STUDIES Carter and Chochinov (2007) performed a systematic review of the literature about the impact of ENPs on cost, quality of care, satisfaction, and wait times in the ED. The researchers focused on four outcome measures: (1) wait times, (2) patient satisfaction, (3) quality of care, and (4) cost-effectiveness. They noted that ENPs decreased wait times while providing quality, comprehensive, and cost-effective ED care, resulting in higher patient satisfaction. A 2008 study of patient satisfaction with NP care in Canadian EDs found that patients were satisfied with NP attentiveness and the comprehensiveness of their care and had a moderate understanding of the ENP role (Thrasher & Purc-Stephenson, 2008). Another Canadian study looked at the impact on patient flow after the integration of NPs and physician assistants (PAs) in six Ontario EDs (Ducharme et al., 2009). That study concluded that the addition of ENPs and PAs to the ED team could improve patient flow in medium-sized community hospital EDs. U.K. STUDIES A 2009 study compared the communication skills and patient satisfaction ratings of ENPs and ED physicians (Sandhu et al., 2009). This study compared the content of, and satisfaction with, consultations made by ENPs and physicians when patients presented to the ED with primary care problems. In the study, the researchers noted that ENPs seemed to focus more on patient education/counseling than did their physician counterparts. The authors noted that there were no statistically significant differences in consultation length. The study also revealed that ENPs had higher levels of self-satisfaction with their consultations than did the ED physicians. U.S. STUDIES In a 2012 study about the effectiveness ED provider in triage (PIT), the authors reported a quality improvement initiative to improve patient flow by redesigning the triage process (Love, Murphy, Lietz, & Jordan, 2012). The ED PIT decreased the time from patient arrival to initial contact with a licensed medical provider from 75 to 25 min. Also, the proportion of patients who left without being seen decreased from 3.6% to 0.9%. Bahena and Andreoni (2013) studied the use of the PIT. They found that using an ENP in triage was a cost-effective method to improve throughput in the ED while providing quality emergency care. Patient satisfaction, quality measures, and financial improvements occurred with the use of a PIT. The authors concluded that an ENP is an excellent ED triage provider option. In addition, the authors noted that by having advanced emergency nursing competencies and decision-making skills, the ENP is a cost-effective provider to improve throughput in the ED while providing quality emergency care. A recent study provided evidence regarding the impact of NPs when compared with physicians. This study addressed the areas of health care quality, safety, and effectiveness from 1990–2009. “A high level of evidence also indicated that patient outcomes on satisfaction with care, health status, functional status, number of ED visits and hospitalizations, blood glucose, blood pressure, and mortality are similar for NPs and MDs” (Stanik-Hutt et al., 2013, p. 492). MORE RESEARCH IS NEEDED We need more quantitative and qualitative studies focusing on patient outcomes when APRNs provide care in the ED. Studies indicate that ENPs can be a valuable resource to manage increased ED service demands, including wait times, LOS, and patient satisfaction. Increased use of ENPs may improve both access to care and patient satisfaction and help make the best use of limited health care resources. Research funding is available from the Centers for Medicare and Medicaid through the National Prevention Partnership Program at www.hhs.gov/ash/nppa-faq.html. For ED quality data, you can also access https://data.medicare.gov/data/hospital-compare/Timely%26&%Effective&20Care (Centers for Medicare & Medicaid Services, 2014). So, let's get researching and get writing. —K. Sue Hoyt, PhD, RN, FNP-BC, CEN, FAEN, FAANP, FAAN Emergency Nurse Practitioner St. Mary Medical Center Long Beach, CA —Jean A. Proehl, RN, MN, CEN, CPEN, FAEN Emergency Clinical Nurse Specialist Proehl PRN, LLC Cornish, NH

Evaluating The Impact of Covid-19 on Nursing Sensitive Quality Indicators: A Multicenter Study ABSTRACT: The COVID-19 pandemic has significantly disrupted healthcare systems worldwide, necessitating a reevaluation of Nursing Sensitive Quality Indicators (NSQIs) to maintain and improve care quality during these unprecedented challenges. This study aims to assess the impact of the COVID-19 pandemic on quality-of-care indicators, specifically examining how the pandemic has influenced the workload of healthcare systems and altered NSQIs within a network of hospitals. Utilizing a multicenter, retrospective, cross-sectional, descriptive design, this study analyzed NSQIs in fifteen hospitals affiliated with a private healthcare group. Data from January 2018 to December 2021 were compared to evaluate the pandemic's effects on patient care quality indicators, including patient satisfaction, pressure injury rates, and thrombophlebitis incidents. The study revealed a significant increase in pressure injuries and thrombophlebitis rates post-pandemic, alongside a decrease in patient satisfaction scores. These findings suggest that the COVID-19 pandemic has adversely impacted nursing care quality, raising concerns about patient safety and satisfaction. However, the data also indicate a generally high standard of nursing care, with low incidence of adverse events and high patient satisfaction overall. The COVID-19 pandemic has markedly influenced NSQIs, highlighting the need for healthcare systems to adapt to maintain high-quality nursing care. Despite the challenges, ongoing evaluation and improvement of NSQIs are crucial for addressing the evolving needs of patients and ensuring effective, patient-centered care. Future strategies should leverage insights from this period to enhance the resilience of healthcare delivery against current and future health crises. Keywords: Nursing Care, Quality Indicators, Health Services COVID-19, Patient satisfaction, Quality in Healthcare Main Points: The study shows that Nursing Sensitive Quality Indicators (NSQIs) in Nursing have undergone significant changes during the pandemic. These changes include increased rates of pressure injuries and thrombophlebitis, as well as decreased levels of patient satisfaction. The findings highlight the profound impact of the pandemic on nursing care quality and patient outcomes. It is crucial to continue assessing and improving NSQIs to maintain high-quality nursing care, despite the challenges posed by the pandemic. The study highlights the importance of health systems adapting their practices to provide patient-centered, safe, and effective care. It also demonstrates the resilience of nursing staff and healthcare organizations during an unprecedented global health crisis. Additionally, it emphasizes the need for innovative strategies and continuous professional development to increase the capacity of the nursing workforce to respond to future challenges. Funding Information This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.