Where: DePaul Hospital, a 450-bed community hospital in St. Louis, Mo.
The issue: Improving patient satisfaction with hospitalist care.
In 2010, Press-Ganey surveys indicated to Sarada Sripada, MD, FACP, that DePaul patients weren't very satisfied with their hospitalists. “The patient satisfaction [scores] for medical floors and the hospitalists working on the medical floors were very low compared to other physicians, like surgeons and OB-GYN doctors,” said Dr. Sripada, practice group leader of the IPC The Hospitalist Company group at DePaul. Specifically, the patient satisfaction on one hospitalist floor scored in the first percentile.
The hospital administration was eager to improve these statistics, and Dr. Sripada had recently received training in quality improvement as a member of the inaugural class of the Fellowship for Hospitalist Leadership program created by IPC and the University of California, San Francisco. For the fellowship's required quality improvement project, she set out to improve patient satisfaction on the low-scoring floor.
“I chose this floor where all the patients are elderly patients going to the nursing homes and patients who need a lot of pain medications,” Dr. Sripada said. “I thought there were a lot of process deficiencies on that floor.”
How it works
The process changes start right at admission, with a “warm welcome.” Dr. Sripada explained: “Whenever a patient reaches the floor, there will be an announcement that the new patient arrived. The charge nurse and another two nurses go there right away and arrange whatever the patient needs right away.”
Better communication is a major focus of the improvements she implemented. The hospitalists now make it a point to educate patients about their disease processes and inform them about the clinical plan for the day, writing down necessary information on a whiteboard in the patient's room.
That educational effort is followed up by nursing staff. “The nurses go back in the afternoon and ask them questions—a teachback about the disease process—so they understand the problems they are having and they can handle it better after they go home,” Dr. Sripada said.
To further improve post-discharge care, the hospital team—which includes case managers and social workers—also arranges follow-up appointments and outpatient medication. “The hospital's outpatient pharmacy helped us out in filling their prescriptions. All of their medications will be delivered to their rooms before they leave the hospital,” said Dr. Sripada.
But the biggest change, Dr. Sripada said, is the implementation of multi-disciplinary rounds, with the physician, nurse, social worker and case manager all seeing the patient at the same time every day to cooperate on the plan of care. “That made a lot of impact on the process,” she said.
The impact was measured in the floor's Press-Ganey results. Patient satisfaction with the nurses, hospitalists and discharge process had increased to above the 90th percentile by September 2011.
Anecdotally, the satisfaction also spread to the clinical staff. “All the physicians and the nurses are really happy and they're satisfied with what they're doing for the patients,” Dr. Sripada said.
That's not to say there wasn't any pushback when the changes were first implemented. “It's a change in the culture of the hospital,” said Dr. Sripada. Better communication can take a little more time upfront, she acknowledged. But the team found that the initial investment saved time in other areas.
“Our phone calls from the nurses actually decreased a lot. The nurses know what's going on with the patients and they can communicate better with the patients and the families,” she said.
After the changes were found to be successful on the pilot floor, they were implemented elsewhere. “We started with one floor and we spread it throughout the hospital,” said Dr. Sripada. “There are five or six hospitals in the system, and we are spreading out to other hospitals.”
She also plans additional study of the effects of the changes. “Our next project is readmissions,” she said. “By doing this, we are expecting readmissions to be decreased, because patients are educated about the disease process and all of the follow-up appointments are made.”