Improve Patient Experience Before, During, and After Care

Improve Patient ExperienceWhen it comes to communicating with patients, nothing beats the immediate connection of text messages. While email and phone calls are increasingly ignored, 90% of text messages are read within three minutes.1

Let’s explore some opportunities to engage with patients via text message throughout their healthcare journey to reduce the cost of outreach and improve the patient experience.

Changing Patient Expectations

The healthcare industry has shifted focus from volume to value, working on the “Triple Aim” of enhancing patient experience (including health and satisfaction), improving the health of populations, and reducing costs.2 Patient satisfaction has become linked to reimbursement at a time when patient expectations for the healthcare experience continue to evolve.

Patients, financially responsible for a sizeable share of their care, are now approaching healthcare encounters with consumer expectations. They expect convenience, personalization, and access to care anytime from anywhere.

Healthcare organizations need new ways to keep patients engaged in their care and to continually assess patient satisfaction. 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, organizations are now focusing on the “Quadruple Aim,” which includes 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.

Below are some strategies designed with the Quadruple Aim in mind, reducing administrative burden with patient, population, and diagnostic-specific automations to engage with patients before, during, and after care.

Before Care

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

Healthcare organizations looking to transform the patient experience should begin by engaging with patients before their scheduled appointments:

  • Care Preparation Instructions – Use procedure-specific pathways to send reminders to start pre-operative instructions.
  • Appointment Reminders – Text patients reminders of dates, times, and locations of upcoming visits, along with detailed wayfinding instructions.
  • Social Determinants of Health (SDOH) Support – Leverage SDOH data to assist patients through barriers, such as sharing coupons for transportation to reduce no-shows. Hennepin Health recently partnered with Lyft to target patients with a history of clinic no-shows, offering them access to a corporate Lyft account to get to their appointments. At the end of a 12-month trial period, no-show rates decreased an aggregate 27%, clinic revenue increased by $270,000, and ROI was 297%.4
  • Patient Intake – Send patients a link to electronic forms to streamline check-in.
  • Real-Time Scheduling Updates – Send status updates to patients to help re-align arrival times when there are scheduling delays.

During Care

The factors that influence a patient’s experience can vary widely based on their reason and length of stay. However, we can follow the broad strokes of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to better identify a patient’s perspective on their care experience.

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. Other questions focus mainly on environmental factors such as cleanliness and sound level.5

From enabling fast, efficient communication between clinicians, patients, and family members to facilitating a more comfortable, safe, and convenient care environment, mobile messaging can greatly improve the patient experience during care.

Video Visits

Texting with patients is a quick and easy gateway into scheduled and/or on-demand video visits. PerfectServe’s solution, for example, enables patients to transition from text message to browser-based video visit with the simple touch of a link—no need to download an app or set up a password.

Virtual Waiting Room

A virtual waiting room uses text messages to maintain a safe and comfortable connection with patients during in-person visits by streamlining check-in to help minimize germ exposure and discomfort.

Patient Family Updates

Family members play a crucial role in supporting patients and encouraging them to follow care plans before, during, and after their stay at the hospital. Healthcare organizations are now prioritizing patient families as part of the patient experience. Family members feel more comfortable leaving the waiting room knowing they will receive updates on patient status and return time.

With PerfectServe, care team members can update approved patient family members via secure video, voice, and/or text message. Even a family member who calls into the main hospital call center can quickly get a message to the correct on-call nurse, who can easily respond with one click, masking their personal caller ID.

Read our white paper for more examples of how the right solution can simplify, automate, and strengthen patient and family member encounters.

Integrate Nurse Call, Alert, and Alarm Notifications

Centralize communication across multiple systems onto a single platform to simplify clinical workflow while eliminating extraneous noise. With a solution like PerfectServe’s Clinical Communication & Collaboration (CC&C), nurses can receive alerts on their mobile devices and choose to accept, escalate for assistance, or call back to speak directly with patients.

If a patient pushes the call button for a nonurgent or nonclinical request (such as a water request), the notification can automatically route to a Patient Care Technician, reducing nurse interruptions during care. Patients benefit from reduced noise and faster response times—critical factors in HCAHPS scores.

After Care

Preventable hospital readmissions continue to be top-of-mind, thanks largely to Medicare’s Hospital Readmissions Reduction Program (HRRP) and readmission penalties. HRRP is the “value-based purchasing program that encourages hospitals to improve communication and care coordination to better engage patients and caregivers in discharge plans and, in turn, reduce avoidable readmissions.”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 applying a text-first strategy to monitor treatment, assess pain, and send care plan reminders (such prescription refill reminders). Care teams can use text messages to deliver questions to patients one at a time or all at once with a simple link to a secure web survey.

Frequently checking in both increases patient satisfaction and allows clinicians to escalate concerning responses to secure chat or phone call if needed. PerfectServe’s solution, for example, lets users share a secure chat link that allows patients to discuss more detailed and personal health information.

Park Nicollet Methodist Hospital worked with PerfectServe to launch a text-first follow-up program that included a series of customized questions to assess a patient’s risk for readmission. 70% of questions sent via text message received a response from patients. PerfectServe’s dashboard allowed Park Nicollet to collect and analyze every patient 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 (results are risk adjusted to account for the relative complexity of each patient’s conditions).

Patient Satisfaction Surveys

While CMS’ HCAHPS survey has incentivized improvements in patient experience, the response rate from patients has been on the decline.9 Declining response rates could be tied to patients’ perception of the survey’s effectiveness. HCAHPS surveys are administered 2 to 42 days after discharge and often cannot yield the timely data hospitals need to quickly address patient issues.

Given the high impact HCAHPS results have on a hospital’s financial performance, it’s important to seize opportunities to survey patients before the CMS in order to preemptively mitigate issues and improve patient satisfaction. For patient satisfaction surveys to be actionable, they need to be easy and customizable, targeting specific patient populations and encouraging meaningful dialogue.

Deploying surveys via text message is a cost-effective approach to obtaining timely patient insights. With solutions like PerfectServe’s Patient & Family Communication (PFC), surveys can be automatically triggered after healthcare encounters while the experience is fresh on the patient’s mind. Patients who indicate dissatisfaction become a service recovery opportunity. Contacting them to show concern and learn more can inform systemic improvement and change the patient’s impression of the organization.

Deliver an Exceptional Experience

PerfectServe allows hospitals to reach patients and their family members in real time before, during, and after care to better support, assess, and improve the patient experience. Book a demo with a clinical communication specialist to see how we can help you deliver an exceptional patient experience.

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Resources:
1. SMS vs Email and Apps: Customer engagement infograph, VoiceSage, Jun. 14, 2018: voicesage.com/blog/sms-compared-to-email-infograph
2. IHI Triple Aim Initiative, Institute for Healthcare Improvement (IHI): ihi.org/Engage/Initiatives/TripleAim
3. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider, The Annals of Family Medicine, T. Bodenheimer, C. Sinsky, Nov. 2014: annfammed.org/content/12/6/573.full
4. Do Rideshare Tools Reduce Transport Barriers, Patient No-Shows?, Xtelligent Healthcare Media, Patient Engagement HIT, S. Heath, Jul. 24, 2018: patientengagementhit.com/news/do-rideshare-tools-reduce-transport-barriers-patient-no-shows
5. The HCAHPS Survey – Frequently Asked Questions, Centers for Medicare & Medicaid Services (CMS): cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Downloads/HospitalHCAHPSFactSheet201007.pdf
6. Hospital Readmissions Reduction Program (HRRP), Centers for Medicare & Medicaid Services (CMS): cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program
7. The association between patient experience factors and likelihood of 30-day readmission: a prospective cohort study, BMJ Quality & Safety, J. Carter et al., 2018: qualitysafety.bmj.com/content/27/9/683
8. Timeliness of Outpatient Follow-up: An Evidence-Based Approach for Planning After Hospital Discharge, The Annals of Family Medicine, C. Jackson, PhD, et al., Mar. 2015: ncbi.nlm.nih.gov/pmc/articles/PMC4369604
9. HCAHPS Survey Non-Response Bias Impacts Scores, Practice Improvement, Xtelligent Healthcare Media, Patient Engagement HIT, S. Heath, May 1, 2019: patientengagementhit.com/news/hcahps-survey-non-response-bias-impacts-scores-practice-improvement

Fighting Alarm Fatigue for Nurses in 5 Steps

Healthcare, We Have a Problem:

Alarm fatigue is a serious threat to patient safety.

The American Association of Critical-Care Nurses (AACN) defines alarm fatigue as a sensory overload that occurs when clinicians are exposed to an excessive number of alarms, which can result in desensitization to alarm sounds and an increased rate of missed alarms. False alarms are a strong contributor, making up 72-99% of all alarms and numbing care teams to signals meant to indicate patient danger.1

Essentially, devices and processes that were designed to protect and support patients in specific ways have compiled over time to create a cacophony of ever-sounding silos in healthcare. Sadly, the discord cannot be safely silenced. Fortunately, it can be well-orchestrated.

Let’s explore how integrating disparate, noisy alert and alarm systems can help fight alarm fatigue for nurses and care teams.

Where is all the noise coming from?

In short, disconnected legacy systems with outdated hardware and devices combine with overlapping, suboptimal workflows to create the noise fueling alarm fatigue. A few factors that add to the chaos and make it difficult for clinicians to determine the relevance and urgency of alarms include:

  • Nurse Call Systems: Patients sometimes use nurse call for non-clinical requests, such as a glass of water, which could be redirected to another team member.
  • Critical Lab Results: Upon notification, nurses in some settings are responsible for tracking down the appropriate physician to relay critical results, pulling the nurse away from the bedside.
  • Patient Monitoring Devices: It can be difficult to infer the risk level and urgency of various patient device alarms, and to know if other team members are responding or can respond more quickly.

Above are just a few of many systems that can trigger nondescript beeping sounds, which all begin to sound alike and blur together. The result? Just to find out where an alarm is coming from and what it indicates, a nurse has to leave the current task to investigate.

The nurse is forced to assign priority (current task versus potential patient threat) based on assumption in an environment where up to 99% of alarms are false, yet assuming an alarm is false puts a patient at risk. Constant decisions like these in a fast-paced, high-stakes environment contribute to mistakes, alarm fatigue, clinician burnout, patient risk, and many other potential consequences.

5 Steps to Fight Alarm Fatigue:

1. Integrate all alerts and alarms to reduce noise.

To start, put all alerts and alarms in one place that nurses and care teams can check on the go—an integrated app accessible from any device across all locations.

2. Increase mobility to decrease footwork.

For organizations that haven’t already deployed a mobile device strategy for nurses, smartphones will greatly enhance the effectiveness of an integrated solution. Being able to check alerts at the bedside and on the move reduces extra footwork and detours for staff.

3. Use shift schedules to inform smart routing.

The ideal solution should also integrate with shift and on-call schedules across the organization, using schedules to route alerts and alarms directly to the right clinicians. Smart routing like PerfectServe’s Dynamic Intelligent Routing reduces irrelevant noise while using built-in escalation policies to ensure urgent alerts are addressed within set timeframes.

4. Delay nonurgent notifications to reduce interruptions.

The ability to delay nonurgent alerts to be delivered at set intervals can greatly reduce distractions for clinicians during patient care. By minimizing multitasking, nurses and other care team members are able to complete tasks more efficiently and maximize their focus on patients at the bedside.

5. Distinguish alert types by tone to simplify recognition.

Alarm fatigue and decision fatigue often go hand in hand. While most care team members wouldn’t actively choose to ignore an alert, the ability to know in an instant based on sound whether or not an alarm is urgent can help them respond appropriately more quickly.

The Bottom Line:

Excess noise makes it difficult for clinicians to administer safe and timely care. (It also does a number on patient experience, but that’s a topic for another post.) Remove the guesswork for nurses around whether to tune out the noise and focus on the patient at hand or interrupt each encounter to assess the latest (likely false) alarm.

Click below to begin fighting alarm fatigue.

 

Resources:
1. Alarm Fatigue: A Patient Safety Concern, American Association of Critical-Care Nurses (AACN) Advanced Critical Care, Sue Sendelbach, RN, PhD, CCNS and Marjorie Funk, RN, PhD, Oct. 2013: acnjournals.org/aacnacconline/article-abstract/24/4/378/14745/Alarm-FatigueA-Patient-Safety-Concern

Real-Time Data Entry for Better Patient Care

Real-Time Data Entry Header

It has always been recommended that charting take place as near to the care event as practical, with the key word being “practical.” In reality, clinicians and nurses often stay after shifts to do their charting because entry is not seamless during patient care.

The more time that passes between the health event and the data entry, the less detailed the data input becomes and the greater its risk of containing errors. Delayed data entry impacts patient outcomes and creates unnecessary administrative overhead.

Benefits of Real-Time Data Entry

“Real-time electronic data is a potential treasure trove of insights, which can be analysed to improve patient care and use nurses’ time more effectively.”
– Helen Glenister, Chief Operating Officer (COO) of The Learning Clinic1

Real-time data entry has been shown to improve patient care (particularly the identification of patients who may be deteriorating), free up more direct-care time for nurses and clinicians, and help hospitals better deploy staff and resources.

According to a study published in Nursing Times, the availability of up-to-date data can help nurses and clinicians spot patterns in data that indicate a patient is deteriorating or may have an infection.1 While some data points may automatically feed into the EHR, vital observational data from nurses and doctors are not automatically entered.

Timely electronic recording of all clinical data—including observations, assessments, and actions—gives the overall picture of a patient and provides a clear data trail in the event of a complaint or incident investigation. Real-time documentation and order entry during rounding also helps speed up care and minimize future interruptions.2

The benefits of real-time data entry are well known, but challenging to achieve in some hospitals.

Challenges to Real-Time Data Entry

Siloed technology systems, device mobility limitations, and logistical issues in some EHRs can be the biggest barriers to real-time charting.

“One nurse believes that since going live, EHRs have added 3 hours to a
12-hour shift.” – Laura A. Stokowski, RN, MS3

In order to chart data that is accurate, actionable, and timely, the care team must be supported with an integrated solution that allows for simplified real-time charting in the EHR/EMR.

How to Achieve Real-Time EHR Data Entry

Healthcare IT integration can be very complex, but the right technology can integrate disparate IT, clinical, telecom, and EMR/EHR systems to allow information to flow freely. The result is a cohesive, integrated communication ecosystem that ensures the right information is available at the right time to support quality patient-centered care.

An ideal solution will support real-time charting with:

  • Intelligent field mapping to reduce duplicate data entry.
  • Voice-to-text capability to speed up and simplify data entry.
  • An easy and elegant interface with all information available on a single platform; no switching between apps.
  • Easy transfer of clinical notes for rapid documentation.
  • Immediate delivery of critical lab and test results to the right clinician with date, time, recipient, delivery status, and read status auto-recorded to the EMR in accordance with Joint Commission requirements.

Next Steps for Getting Started

Explore how your team can combine real-time EHR data entry with seamless care coordination in one integrated solution by speaking with a clinical communication specialist.

 

Resources:
1. How real-time data can improve patient care, Nursing Times, Sep. 21, 2015: nursingtimes.net/clinical-archive/patient-safety/how-real-time-data-can-improve-patient-care-21-09-2015/
2. How Hospitalists Can Improve Efficiency on Inpatient Wards, The Hospitalist, Rajesh Chandra, MD, FHM, et. al., May 2014: the-hospitalist.org/hospitalist/article/126231/how-hospitalists-can-improve-efficiency-inpatient-wards
3. Electronic Nursing Documentation: Charting New Territory, Medscape, Sep. 12, 2013: medscape.com/viewarticle/810573