|Patient Experience Case Study - Yale-New Haven Hospital|
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Creating a Culture of Family Satisfaction Assessment in Critical Care
What was the challenge, opportunity or issue faced?
Standard HCAHPS surveys currently provide limited insight into the experience of patients hospitalized in neuroscience intensive care units (ICUs) and their families. The HCAHPS survey (1) is meant to be filled out by patients only, when many brain injured patients are unable to do so reliably; (2) excludes patients who are discharged to skilled nursing facilities or hospice; where a substantial number of neuroscience ICU patients are transferred following hospitalization; and (3) does not contain questions to differentiate between a patient’s experience while in an ICU versus while on a regular inpatient floor. We thus sought to collect specific data on satisfaction with care from patients’ families in our neuroscience ICU for use in quality improvement initiatives.
What did you do to address it?
For several years, we have administered the FS-ICU 24 survey, a validated survey for assessing family satisfaction with ICU care, to families of consecutive patients discharged from our dedicated neuroscience ICU, including those families whose loved ones passed away during hospitalization. Our project has been approved by our institution’s Human Research Protection Program, which has allowed us to collect information simultaneously about our patients’ and families’ characteristics as well.
Without a dedicated research coordinator, our group has taken a team approach to achieving consistent data collection. Team members have included an MD; advanced practice providers; nursing leadership and bedside nurses; unit clerks; and medical, physician assistant and undergraduate students. Surveys have been administered in person for families of ICU survivors who are discharged to the floor and by mail for families of non-survivors.
What were the outcomes?
Overall, we have been able to achieve a capture rate of about 50% of eligible families for our ongoing survey study. Throughout the initiative, we have identified areas needed for improvement from the survey results and can now use the ongoing survey collection to assess whether new initiatives to improve family satisfaction have made an impact. For example, the initial survey results suggested that the frequency of communication of physicians with families needed improvement, as did our waiting room environment.
We have since implemented dedicated "family rounds” two afternoons a week, during which the ICU attending on service and nursing leadership walk from room to room in the unit and specifically talk with patients’ families. We have also renovated our waiting area. Our group is in the midst of analyzing our survey data both pre- and post-implementation of these changes to directly assess how they have been received by our patients’ families.
About Yale-New Haven Hospital
Yale-New Haven Hospital is the main teaching hospital affiliated with the Yale School of Medicine and Yale School of Nursing. The hospital is a Comprehensive Stroke Center and has achieved magnet status by the American Nurses Credentialing Center. Our neuroscience ICU is a 14-bed unit that cares for both primary neurology and neurosurgery patients, many of whom are referred or transferred from outside the New Haven area. The ICU is staffed with neurocritical care attendings; neurosurgeons; fellows; residents; advanced practice providers; nurses; respiratory therapists; and a team of speech, physical and occupational therapists.