Magnet Recognition Program® Status

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.

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a publicly reported tool that measures patient satisfaction. As both patients and Centers for Medicare & Medicaid Services (CMS) reimbursement rely on survey results as a metric of quality of care, we reviewed the current literature to determine if patient satisfaction correlates with quality, safety, or patient outcomes. We found varying associations between safety culture, process of care measure compliance, and patient outcomes with patient satisfaction on the HCAHPS survey. Some studies found inverse relationships between quality and safety metrics and patient satisfaction. The measure that most reliably correlated with high patient satisfaction was low readmission rate. Future studies using patient specific data are needed to better identify which factors most influence patient satisfaction and to determine if patient satisfaction is a marker of safer and better quality care. Furthermore, the HCAHPS survey should continue to undergo evaluations to assure it generates predictable results.

Aligning Healthcare Safety and Quality Competencies: Quality and Safety Education for Nurses (QSEN), The Joint Commission, and American Nurses Credentialing Center (ANCC) Magnet® Standards Crosswalk

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

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

Centers for Medicare and Medicaid Services' Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and gynecologic oncology surgical outcomes

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

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.

Patient experience scores are hospital-centric metrics, which are becoming increasingly important in healthcare quality assessment; however, the factors that influence these scores are poorly defined. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a nationally administered, publicly reported patient experience survey that exerts a major influence on hospital reimbursement by the Centers for Medicare and Medicaid Services (CMS). The purpose of this study was to investigate the correlation between HCAHPS scores and postoperative patient-reported outcome measures (PROMs) up to 5 years after elective cervical and thoracolumbar spine surgery. All patients who had undergone elective spine surgery at a single academic tertiary center in 2010-2019 were potentially eligible for study inclusion. PROMs used in the study included the Neck Disability Index (NDI), Oswestry Disability Index (ODI), 10-Item Patient-Reported Outcomes Measurement Information System Global Health survey (PROMIS GH-10) global mental health (GMH) and global physical health (GPH) parameters, and patient acceptable symptom state for neck and back. Patients were excluded for surgical indications such as trauma, infection, or neoplasia or for missing PROM data. HCAHPS scores were collected from the electronic medical record and had been originally obtained via text message. Correlation analysis and longitudinal data analysis were used to assess relationships between PROMs and HCAHPS scores (α = 0.05). Three hundred ninety-seven patients with recorded PROMs were included in the study; 124 had undergone elective cervical surgery and 273 had undergone thoracolumbar surgery. HCAHPS scores showed small but significant correlations with NDI and the PROMIS GMH component 6 months after cervical surgery; however, no significant correlations were seen beyond 6 months. Additionally, there was no significant relationship between HCAHPS and postoperative PROMs following thoracolumbar surgery. Hospital experience scores, as assessed using the HCAHPS, show limited correlation with PROMs after elective spine surgery. While the HCAHPS currently plays a critical role for the CMS in determining hospital reimbursement rates, the study findings suggest that patient perceptions of inpatient care do not necessarily reflect their long-term functional outcomes. This result highlights the need for a multidimensional approach to evaluating healthcare quality, incorporating both short-term patient satisfaction and meaningful, enduring improvements in clinical outcomes.

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.

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

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

Patient satisfaction with care is an important indicator of quality of care. As of 2013-2014, 30% of the Value-Based Purchasing score Medicare is using to determine hospital reimbursement is based on patient reports of care. This study determined whether significant relationships exists between Magnet (N = 160), Magnet-in-progress (N = 99), and non-Magnet hospital (N = 1,742) status and the highest ratings on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey questions related to patient satisfaction with care. This study was a secondary analysis of data collected and compiled from three sources (the American Hospital Association, American Nurses Credentialing Center, and HCAHPS databases). Analysis revealed that Magnet and Magnet-in-progress hospitals have significantly (p < .007) higher scores than non-Magnet hospitals on six of the seven questions regarding patient-reported satisfaction with care. The implications of these results for nursing are discussed.

In 1995, the American Pain Society declared pain as the fifth vital sign. Pain is one of the primary fears of patients undergoing surgery. Pain is inadequately treated in as much as 50% of patients and more than 80% of patients receiving surgery experience some degree of pain1,2. Orthopaedic procedures, in particular total joint arthroplasty (TJA), are painful. Pain is known to compromise the early outcome of TJA by affecting patient ambulation and compliance with physical therapy. Inadequate pain control increases the length of hospital stay, escalates the cost of care, and is associated with venous thromboembolism, coronary ischemia, myocardial infarction, pneumonia, insomnia, cognitive dysfunction, poor wound-healing, and slowed overall recovery. Experiencing severe pain during the postoperative period can lead to patient demoralization and dissatisfaction1,3,4 and may lead to chronic pain syndrome. Control of pain following TJA, particularly total knee arthroplasty, remains imperfect. There has been an impetus among orthopaedic surgeons to seek novel, and potentially more effective, pain management strategies. Multimodal pain management, introduced by Wall in 19885 and popularized by Kehlet and Dahl in 19936, has been a great advance in postoperative pain management. The intention of multimodal pain management is to target different pain pathways for effective pain relief, without solely resorting to opioids. The term multimodal pain management is broad and all encompassing. Injection of a local anesthetic to the periarticular region of the knee, as performed in the three highlighted Evidence-Based Orthopaedics7-9 studies in this issue of The Journal of Bone and Joint Surgery (American Volume), has been used for more effective pain control. These authors conducted high-level studies that add further support for the use of periarticular infiltration of anesthetic agents. Murphy et al.7 showed that periarticular injection of levobupivacaine resulted in a reduction in opiate consumption, although the pain scores were not reduced. The study by Essving et al.8 demonstrated that periarticular injection of ropivacaine, ketorolac, and epinephrine resulted in reduction of morphine consumption during the first forty-eight postoperative hours. Continuous delivery of a local anesthetic through an indwelling catheter placed into a joint after TJA or infiltration of various agents into the periarticular region are other strategies that have been explored recently. The study by Dobrydnjov et al.9 provides evidence that infusion of intra-articular (vs. extra-articular) ropivacaine was effective in reducing the incidence of high-intensity pain and improving initial mobilization. These studies support the need for orthopaedic surgeons to seek alternative avenues for postoperative pain control. At my institution, and following the execution of a Level-I study, we abandoned the use of epidural anesthetic agents in favor of intra-articular infusion of anesthetic agents. Of note, there may be potential for development of infection with infusion or infiltration of a large volume of fluid periarticularly. There have also been several other advances in analgesic drug development and delivery. Liposomal delivery of morphine into the epidural space, liposomal delivery of bupivacaine into the surgical wound, intravenous formulations of acetaminophen and ibuprofen, transcutaneous iontophoretic delivery of fentanyl with use of a small credit-card-size electronic device, and intranasal delivery of analgesics are just a few of the advances that have been made in recent years. Preconditioning of the patients (with better preparation for postoperative rehabilitation) and avoidance of excessive soft-tissue dissection (with a shift toward tissue-sparing approaches) may also reduce the degree and intensity of postoperative pain following TJA. Perhaps the most significant and important advance in the field of pain management has been the recognition that inadequate pain control following surgery is not acceptable in contemporary society. Patient satisfaction data are now being reported through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). As part of the Affordable Care Act of 2010, the Centers for Medicare & Medicaid Services (CMS) have established hospital reimbursement levels on the basis of HCAHPS scores. With the changing climate of health care and emphasis on patient satisfaction with episode of care, and possible identification of pain as a “quality” metric, better management of pain will become even more pressing in the future. The authors of the three articles highlighted here have provided concrete steps in the elimination of this common enemy.

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