Improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Scores in Bone Marrow Transplant Inpatient Setting

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized survey for measuring patients' perception of their hospital experience. It is intended to improve quality of care, allow comparison of hospitals on topics that are important to consumers and enhance accountability in healthcare by increasing transparency of the quality of hospital care. HCAHPS has been a primary focus of our hospital in assessing quality of care at the BMT unit.

HCAHPS surveys were mailed to a random sample of BMT patients 48 hours to 4 weeks post discharge from the unit. Surveys returned between May 2012 and September 2012 (group A, n=25) were reviewed (table 2). HCAHPS scores were below the required target of 75% in all areas.   A quality improvement plan (table 1) was implemented to help improve HCAHPS scores and targeted physician communication, nursing communication, pain management and discharge planning.  

Table 1: Hospital Consumer Assessment of Healthcare Providers and Systems Improvement Plan

1-Nurse will be present in the patient's room during daily physician visit 2-Physicians will try to sit down during communication with the patient and always ask patient   if all concerns were adequately addressed at the end of each visit. 3-Nurses will perform hourly rounds on patients. 4-Patients' pain will be assessed on a daily basis through joined physician/nursing round 5-Discharge process:  -instructions about diet, activity and follow up provided by physician or midlevel -written discharge instructions provided by nrse -Discharge medications filled by BMT pharmacist who discusses the medications with patient and caregiver, fills the pill box and provides written instruction for indications, schedule and side effects. -Physician or midlevel will review discharge instruction and medication list within 48 hours of discharge in the outpatient setting. -Outpatient clinic nurse will follow up on line care and supplies.

After implementing the HCAHPS improvement plan, 19 patient surveys (group B) were returned from October till April 2013.The satisfaction scores were all above the 90^th percentile reflecting a significant improvement in patient experience.

Table 2: HCAHPS scores before (group A) and after (group B) implementing quality improvement Plan

HCAHPS Measures	Group A (n=25)		Group B (n=19)
	Top box	Percentile among hospital units	Top box	Percentile among hospital units
Recommend Hospital	64	63%	95	99%
Communication with Nurses	72	29%	100	99%
Response of hospital staff	36	1%	83	97%
Communication with Doctors	81	54%	95	99%
Pain Management	69	39%	95	99%
Discahrge information	92	75%	100	99%

Our Data shows that HCAHPS scores can be significantly improved through a cohesive plan based on close communication between all team members and assessing patient needs on a more frequent basis.