Background: The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey is the first national, standardized, publicly reported survey of patient perspectives of hospital care. HCAPS scoring is tied not only to hospital compensation, but also is an important indicator of and reflection of interactions with patients. Specifically at Rhode Island Hospital, the goal is to improve patient interactions. The main category identified as needing improvement was the listening category. In the HCAHPS survey, physician listening is identified by the following questions:Did your doctor treat you with courtesy and respect?Did your doctor listen carefully?Did your doctor explain your medical information in a way you could understand?HCAHPS is a reflection of physician relationship with patients and influences adherence to plan after discharge. It also has an impact on readmission rates and mortality. It is tied to hospital compensation and can enable delivery of high value care. Also bedside rounding has previously been investigated as a tool to help improve patient reported outcomes.
Purpose: The purpose of this study was to identify an intervention that could help with improvement of the listening category of HCAHPS. We sought to survey patients about their current experience in the hospital, specifically in regards to physician interaction. Subsequently, we implemented a standardized intervention on the teaching service at Rhode Island Hospital. The overall goal was to increase the HCAPS score by 1% in the course of first quarter of the fiscal year.
Description: Bedside rounding was identified as the main intervention given previous evidence supporting improvements in patient experience. This was subsequently implemented on the teaching medicine service at Rhode Island Hospital. The intervention included developing a standardized survey. After development, we surveyed patients at outset prior to initiating standardized bedside rounds. We educated residents during noon conference to preface the intervention and present data. In addition, we performed a faculty staff meeting to discuss implementation of bedside rounding and feasibility. After coming to a consensus on the standardized bedside rounding process, we implemented the standardized bedside intervention. We finally performed the standardized survey at conclusion to assess patient responses after intervention.
Conclusions: In this Quality Improvement initiative, standardized bedside rounding was used as a tool to improve patient centered outcomes related to physician listening. During the implementation process, teaching internal medicine teams performed bedside rounding to varying degrees. Analysis using two sample t test revealed a p value of 0.35 specifically in regards to explanation of the plan, pointing away from statistical significance. This may be due to small sample size and population as well as variable implementation through the program. Further, these results reflect data after only two weeks of implementation. Prior studies as cited below have demonstrated variable benefit of bedside rounding, with some statistically significant improvements in patient experience but not in patient knowledge. A more longitudinal study as well as an analysis after more consistent standardized implementation and patient surveying may yield significant results. The end result is yet to be seen whether bedside rounding ties into HCAPS scores and improving physician listening.
