Background: Patient experience is one of the key foundations of quality care. The Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) is the standard measurement of patient experience, and higher scores have been linked to improved clinical outcomes and reduced readmissions. Few published interventions have improved HCAHPS scores in inpatient settings. Interventions utilizing real-time feedback demonstrated some success in improving the “doctor communication” domain, but not other HCAHPS domains.

Purpose: To develop and implement a real-time survey for medical inpatients to provide feedback and guide the interdisciplinary team in improving the experience of the patient surveyed.

Description: This interdisciplinary quality improvement initiative was implemented on a 34-bed medical unit in a large, tertiary medical center from July 1, 2017 – June 30, 2018. The survey consisted of 5 questions that asked patients to rate on a 1-5 Likert scale: doctor communication, (2) nurse communication, (3) education received on their medications, (4) discharge planning, and (5) overall experience. Additional comments were solicited. Eligible patients spoke English, were alert and oriented, and on the medical unit for >24 hours. Survey answers were inputted into a mobile application that allowed the responses to be immediately sent by email to all members of the unit’s interdisciplinary team. An action plan was made in conjunction with the attending of record, medical director, nurse manager, patient service representative, food service and housekeeping liaisons (when applicable) to execute within 24 hours.
All survey responses and number of interventions were recorded. Data were analyzed for over-arching themes. The percent ‘always’ responses of HCHAPS were compared pre- and post-intervention. A total of 235 surveys were obtained during the intervention period, of which 94 (35.5%) had at least one item rated 3 or lower on any question or provided a negative or actionable comment. Of these 94, targeted interventions were completed within 24 hours if the patients had not been discharged. Predominant themes of concerns included communication with staff (10.6%), responsiveness of staff (10.2%), medication teaching (4.5%), and food service (3.4%).

Mean percentage of ‘always’ responses on the HCAHPS during the 12-month intervention period were compared to 12 months prior. The following domains improved (Table 1): hospital rating over time, willingness to recommend the hospital, doctor communication, nurse communication, responsiveness of hospital staff, medication communication, discharge information, care transition, and quietness at night. Of these, nurse communication and responsiveness of staff were statistically significant.

Conclusions: Obtaining real-time feedback during hospitalization allowed for active service recovery and improved patient experience. By involving the entire interdisciplinary team, a positive effect was seen in the majority of HCAHPS domains.

IMAGE 1: Table 1