Improve Patient Experience Before, During and After Care

improve patient experience

When it comes to communicating with patients, nothing beats the immediate connection of text messages. While email and phone calls face diminishing open and answer rates, 90% of text messages are read within 3 minutes.1

Combine the timeliness of texting with the relevance from patient context, and you have a powerful tool to communicate with a patient when and where it matters most. In this post, we will examine the opportunities to engage with patients across the spectrum of care, improve outcomes, reduce costs, and improve the patient experience.

Changing Patient Expectations

The healthcare industry has shifted from volume to value, working on the Triple Aim of improving patient populations, individual patient health and satisfaction, and reducing costs.2 At the same time as patient satisfaction is being linked to reimbursement, patient expectations for their healthcare experience continue to increase.

Patients, now responsible for a greater financial share in their care, are approaching their care experiences with consumer expectations. Patients expect convenience, personalization, and involvement in their care anytime, anywhere. With patient experience and satisfaction now moving targets, healthcare organizations need ways to engage patients in their care and to continually assess the success of their efforts.

Unfortunately, improving health system performance toward Triple Aim results has led to worrying rates of clinical burnout. With technology often cited as one of the leading causes of burnout, we are now seeing healthcare organizations focus on the Quadruple Aim, including provider experience and satisfaction.3 The Quadruple Aim recognizes the importance of usability, effective care processes, and improved clinical workflows to achieve Triple Aim results.

The patient engagement strategies below are designed with the Quadruple Aim in mind, reducing administrative burden with patient, population, and diagnostic-specific automations to engage with patients across the care continuum.

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Patient Preparation

How a patient experiences their healthcare encounter begins long before the patient even steps through your door. From their perception of your website and scheduling processes to your preparation and intake processes, patients are looking for modern, seamless, and informative experiences.

Healthcare organizations looking to transform their patient experiences can begin by engaging with patients before their scheduled appointments, including:

  • Care Preparation Instructions – reminders to fill or take prescriptions or start pre-operative instructions based upon procedure-specific pathways
  • Appointment Reminders – reminders of the date, time, and location of an upcoming visit with detailed wayfinding instructions
  • SDOH Support – leveraging social determinants of health (SDOH) data, reminders can include coupons for transportation to reduce no-shows
  • Patient Intake – send patients a link to electronic forms to support off-site check-in

In addition to automating preparation and intake, you can leverage automations to keep patients “in the loop” day-of-procedure. For example, scheduling delays can trigger a status message to patients to re-align their arrival time.

Hennepin Health, in partnership with Lyft, recently targeted patients with a history of clinic no-shows, allowing them access to a corporate Lyft account to get patients to their appointments. At the end of the 12-month trial period, no-show rates decreased an aggregate 27%, clinic revenue increased by $270,000, and ROI was 297%.4

During Care

Although the factors that influence a patient’s experience vary widely based on the reason and length of stay, we can follow the broad strokes of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to identify a patient’s perspective on their care experience.5 The 18 substantive questions included in the survey focus primarily on communication with doctors, nurses, and staff during care and at the critical point of discharge. Outside of this, questions focus mainly on environmental factors such as cleanliness and sound level.

PerfectServe’s clinical collaboration solution is designed to enable fast, efficient communication that enhances care and improves the patient experience.

Integrate Nurse Call, Alert and Alarm Notifications

We centralize communication across multiple systems onto a single platform to simplify clinical workflow while eliminating extraneous noise. Nurses receive alerts on their mobile devices and web apps, where they can accept, escalate for assistance, or call back to speak with the patient directly. If the call button is non-urgent (such as a “water” request), it can automatically route to the Patient Care Technician, reducing nurse interruptions. Patients benefit from reduced ward noise and faster response times – critical factors in HCAHPS scores.

Family Communication

Family members play a crucial role in supporting patients during their stay at the hospital and in encouraging compliance with care plans. Healthcare organizations are recognizing the importance of supporting families as part of the patient experience as well.

With pre-configured pathways, families can feel more comfortable leaving waiting room areas knowing that they will receive an automated message with patient status and return time. If a patient’s family member calls into the main hospital call center and are connected to the appropriate nurse, the nurse can return the call with one click. To ensure the correct on-call nurse is contacted in the future, the return call number is hidden.

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Post-Discharge Assessments and Surveys

Following the most recent round of Medicare readmission penalties levied against 2,583 hospitals, preventable hospital readmissions continue to be top-of-mind.6

According to a study published in BMJ Quality & Safety, patients reporting high satisfaction and good provider communication were less likely to be readmitted.7 Decreasing preventable readmissions requires that patients understand and adhere to their care plan, that pain is managed, and that follow-up care is scheduled and attended in less than two weeks.8

Post-Discharge Assessments

Leading hospitals are leveraging text-first interactions to monitor care, assess pain, and send care plan reminders (such as filling or starting a prescription). Questions can be delivered one-at-a-time to encourage response or patients can be prompted to a secure web form for a full survey or to share detailed personal health information. Frequent check-ins not only increase patient satisfaction but also allow clinicians to escalate concerning responses to a secure chat session or phone call.

Park Nicollet Methodist Hospital adopted a text-first follow-up program that included a series of customized follow-up questions to assess a patient’s risk for readmission. 70% of questions sent via text message receive a response rate from patients. The PerfectServe dashboard collects and analyzes every patient’s response and nonresponse, segmenting the patient population into risk categories and automatically flagging patients that need immediate follow-up.

Park Nicollet’s results showed that patients who received and responded to text messages were 32% less likely to readmit than those solely contacted by phone. (These results are risk-adjusted to account for the relative complexity of each patient’s conditions.)

Patient Satisfaction Surveys

The goal of any patient satisfaction survey is to gain honest insight into the patient experience. Although the HCAHPS survey has incentivized improvements in patient experience, the response rate for patients has been on the decline, down to just 26.7% from July 2017 to June 2018.9 Administered 2 to 42 days after discharge, surveys do not yield the timely data hospitals need in order to act on patient satisfaction.

Given the high impact of HCAHPS results on a hospital’s financial performance, there is an opportunity to survey patients before the CMS to mitigate issues and improve patient satisfaction in advance.

To make patient satisfaction surveys actionable, healthcare organizations need easy, customizable surveys that target specific patient populations and encourage meaningful dialogue. Surveys can be automatically triggered after the healthcare encounter while the experience is fresh on the patient’s mind. Deploying text message surveys and text-first surveys is a cost-effective approach to obtaining these coveted patient insights.

Patients indicating dissatisfaction present a service recovery opportunity – contacting them to show concern and learn more about their experience will not only inform systemic improvement opportunities but also will likely change the patient’s impression of the organization.

PerfectServe allows hospitals to reach patients and/or families in real time before, during, and after care to better engage, activate, and assess patients in their care experiences. Post-discharge assessments present an opportunity to evaluate patient satisfaction and address patient concerns while there is still time to directly improve their satisfaction.

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1 https://www.voicesage.com/blog/sms-compared-to-email-infograph/

2 http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx

3 http://www.annfammed.org/content/12/6/573.full

4 https://patientengagementhit.com/news/do-rideshare-tools-reduce-transport-barriers-patient-no-shows

5 https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Downloads/HospitalHCAHPSFactSheet201007.pdf

6 https://khn.org/news/hospital-readmission-penalties-medicare-2583-hospitals/

7 https://qualitysafety.bmj.com/content/27/9/683

8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369604/

9 https://patientengagementhit.com/news/hcahps-survey-non-response-bias-impacts-scores-practice-improvement

The important role nurses play in care transition and reducing readmissions

In its simplest form, “care transition” is defined as a hospital discharge or movement from one care setting to another. The risk that readmissions pose to patient safety requires that transitional care processes are under constant evaluation.

Nurses are the linchpin in the coordination of patient care, and thus are best equipped to coordinate a successful transition. The bedside nurse, for example, may understand a great deal more about the patient’s needs as they travel through the care continuum than other care team members. And when those needs are communicated effectively, the nurse is given the opportunity to extend to the patient high-value care beyond organizational boundaries.

Nurses create transitional care plans by compiling all the pertinent patient information and creating instructions to be followed. Then they share the plan in detail with all members of the new care team so that the handoff is seamless for both the patient and the new unit or facility.

The most important factor in transition of care is communication during the handoff process.

What to communicate and when

The goal of the handoff is to safely transfer the patient from one care setting to another (or to discharge the patient from the hospital completely) by exchanging the necessary information with, and by effectively transferring the responsibility of care to, either a new care team or the patient’s family.

It’s a lot to put on any nurse’s plate, but by standardizing and implementing an effective and comprehensive transition communication process, nurses can elevate patient safety, avoid adverse events that lead to costly readmissions and decrease patient anxiety during the transfer process.

It’s important to remember that the transfer process doesn’t apply only to moving a patient from an acute setting to the home or a post-acute environment. There are many different handoff scenarios within the same organization, unit and floor that need your close attention.

For example, nurses should be prepared to provide handoff communication:

  • At shift change
  • During a break
  • When patients are transferred within the hospital (e.g., from the ER to ICU, from radiology to the OR, etc.)

It’s extremely important for the purposes of continuity of care that the communication between the nurse and either the new team of clinicians or the family prepares them in such a way that they’re able to anticipate the patient’s needs and make timely decisions.

At a high level, to adequately prepare the new care team, the following should be included in the handoff communication:

  • Patient care instructions
  • Treatment description
  • Medication history
  • Services received
  • Any recent or anticipated changes

More specifically, and especially in the case of transfers to a new care team or facility, an effective care transition communication plan will include:

  • Patient’s name and age
  • Reason for admission
  • Pertinent co-morbidities
  • Code status
  • Current isolation or precautions
  • Elopement risk
  • Lab results—including any pending and/or abnormal findings
  • Relevant diagnostic studies
  • Fall risk assessment
  • Any assessment findings that are appropriate to the patient’s current health

Many times, nurses on the receiving team care for patients for whom they lack pertinent health data. For example, EKG results are often left out of the transition communication between hospitals and subacute rehabilitation facilities. In this case, if a patient has an episode of chest pain, the receiving team could conduct an EKG on their own, but without prior results to compare with, they can’t successfully rule out something dangerous, such as angina. So, they may err on the side of patient safety and send the patient back to the hospital, resulting in a readmission. However, if an EKG result is included in the transition communication, the receiving team can conduct an EKG on their own, compare the results with the EKG performed at the hospital, and determine whether there is an emergent need for a readmission or the issue is something they can safely handle in their own setting.

Pay extra close attention to medication communications

While including all pertinent test results in the handoff communication is extremely important, there’s another area that needs special attention, because it causes more admissions than any other factor: medication.

It’s estimated that 30% of hospitalized patients have at least one discrepancy on discharge medication reconciliation. Communicating medication details is an area that poses the greatest risk for error as well as the greatest opportunity to effect a positive outcome. In fact, over 66% of emergency readmissions for patients over 65 years old are due to adverse medication events.

Breaches in handoff, such as failure to include specific details of the patient’s medication history and future dosage needs, have dire consequences.

However, defective handoffs are also known to cause problems beyond adverse events. Issues such as delays in care, inappropriate treatment, and increased length of stay arise when transition communication is not strategically planned and delivered.

There are many root causes of a defective handoff, but since nurses play the most important role in the transition communication process, you must strategically develop and communicate the transitional care plan—not only by considering what information you believe should be communicated, but by extending a dialogue to the receiving team and understanding what information they feel is necessary to provide the best follow-up care possible.

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