Admission & Discharge

HCAHPS scores Closely Tied to Readmission Rates

Posted on March 28, 2013. Filed under: Admission & Discharge, Communication, HCAHPS, Patient Experience |

ImageWith Medicare payment penalties for excess readmissions now in effect, reducing readmissions has become a top priority for hospitals and other stakeholders. The Centers for Medicare and Medicaid Services (CMS) publicly reports risk-adjusted readmission rates for heart attack, heart failure and pneumonia. The data shows significant variation in performance across hospitals, indicating that some hospitals are more successful than others at addressing the causes of readmissions. A recent study by Press Ganey suggests that performance on readmission metrics is associated with performance on patient experience of care measures.

Press Ganey analyzed hospitals’ readmission penalty data in the context of their scores for CMS’ Hospital Inpatient Value-based Purchasing program (VBP) to determine if there was a relationship in performance on the two pay-for-performance programs. The VBP program establishes scores for both the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results and process of care measures. The study found a demonstrated negative association between hospitals’ HCAHPS VBP scores and readmission penalties; as hospital performance on HCAHPS increased, readmission penalties decreased. Very low HCAHPS performance (scores of 0–19 was associated with much-higher-than-average readmission penalties, and very high HCAHPS performance (80–100) was associated with much-lower-than-average readmission penalties.

These findings support previous research on the link between patient experience and clinical quality found that higher overall patient satisfaction and satisfaction with discharge planning were associated with lower 30-day risk-standardized readmission rates. This current study seems to suggest, HCAHPS scores, not clinical measures, were more closely linked to readmission rates.

To effectively combat patient readmissions, hospitals can benefit from a foundational strategy that starts first and foremost with the patient – and efforts that are aimed at improving HCAHPS scores are an excellent initial step. The majority of the HCAHPS survey questions address communications between caregivers and patients. Effective communications is fundamental to ensuring that patients become engaged in their care and, consequently, better equipped to follow discharge instructions and self-monitor after leaving the acute care setting.

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Guide for Nurses During Admission and Discharge

Posted on February 17, 2013. Filed under: Admission & Discharge, Communication, HCAHPS, Introcomm Services, Post By Christy Whipple |

Nursing-AdmissionThere are many things to consider when admitting or discharging a patient in a health care facility. Introcomm can assist healthcare facilities with numerous admissions and discharge objects, especially focusing on clear and concise communication between the healthcare staff and the patient/family.

The following checklist, inspired by a nursing school lesson plan from the Texas Education Agency, contains suggestions and recommendations for guiding a patient through a smooth admissions and discharge process. Please contact us to learn more about utilizing our customized communications toolkit.

Greeting the Patient

Specific admission procedures will depend on the policy of the healthcare facility, however many of these recommendations are relevant for most hospitals and facilities. In some healthcare facilities, the patient is taken directly to the room, where the actual admission process begins. Most facilities, however, start the admission process in the admitting office. A preliminary interview of the patient is done to obtain the necessary medical and financial information.  It is important for the family to remain with the patient for this interview.

The First Impression

1. Greet each patient in a friendly, cheerful manner.
2. Introduce yourself, and take the patient to their room.
3. If the patient has a friend or relative with him/her, invite them to accompany you to the room.
4. Introduce the patient to other healthcare providers in the room.

Communication Throughout the Admission Procedure

Statistics show that HCAHPS scores are improved when healthcare providers help the patient become familiar with the new surroundings. Even simple explanations can help the patient feel more connected and cared for by the hospital staff.

1. Explain the facility’s policy on visitors, and the use of the television and telephone.
2. Demonstrate how to use the signal cord system, remote-control television and automatic bed controls.
3. Tell the patient when meals are served.
4. Answer any questions he/she has about scheduled procedures and daily rounding.
5. Comfort the patient by showing him/her where personal items are stored
6.  Make a list of the clothing and personal items the patient has, have the patient or a member of the family sign the list, give a copy to the patient and to the nursing supervisor to include in the patient’s chart.

Communicating With Family During Admission

1. Create an atmosphere of warmth and understanding for the patient and the patient’s family.
2. Always be courteous and helpful to the patient and the patient’s family.
3. Kindly communicate with family members during times when they may be required to leave the room.
4. Promptly alert the family when they may return to the patient’s room.
5. If the patient is unable to answer the admission questions, have a family member help you with the information needed

Planning for the Patient’s Discharge

There are many things to consider when planning for the patient’s discharge.  If the illness has not been long, complicated, or severe, there may not be special preparations other than general health instructions and information concerning the actual discharge (such as the time and date the patient will be discharged).  For other patients, the discharge process is more complicated. The patient’s attitude towards discharge and continued progress toward recovery must be considered. If being discharged to home, the patient may need reassurance that recovery will continue at home.

The nurse should make sure the patient has been given instructions by the doctor for home care and understands the instructions for:
1. Taking medications
2. Exercise programs
3. Physical therapy
4. Changing dressings
5. Giving injections
6. Respiratory treatments that will be continued at home.
* If possible, the nurse should give the patient a written copy of the instructions, such as a copy of the diet or an appointment card for a return visit to the doctor

Patient care does not end when the patient is discharged. The patient may receive visits from a home health agency to supervise the care and treatment.  The patient’s home care should make use of existing community resources so the patient and the family will not have to undertake the financial and emotional burden. The patient may be concerned about being able to manage for himself/herself.  These worries may keep the patient from looking forward to leaving the healthcare facility. The patient may wonder what kinds of treatment, if any, will be needed at home and how it will be done. Provisions for special nursing care, such as provided by visiting nurses, may be needed for the patient who is unable to manage his/her own hygiene and personal care.  An important consideration may be whether help will be required for meals, grocery shopping, etc., for a patient living alone and how long such help will be needed. 

Visit us at www.introcomm.com to learn more and to request your FREE educational webinar.

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