Ambulatory Surgery Center (ASC)
Patient Satisfaction:
Striving for 5’s Through Patient Communication
Kelli Clifton-Graduate Administrative Intern
Office of the President/Department of Surgical Services
2010 MHA Candidate-The Ohio State University
Summer 2009
Agenda
•
Problem Identification and Purpose of Project
•
Selection of Pilot Locations
•
Electronic Discharge Instruction
•
Olson Discharge Process Re-design
•
Organizational Impact of Project
Problem
For the baseline period of Q3 FY 09, the overall ASC patient
satisfaction goal was 75.7% (VG). In comparison, the actual
overall ASC patient satisfaction score was 71.4%(VG) ( 4.3%).
Purpose of Project
Develop a perioperative experience that includes timely,
consistent and accurate information for Ambulatory Surgery
Center (ASC) patients and families
–
–
Directly supports Best Patient Experience (BPE) strategic plan
Specific focus on patient satisfaction, measured by Press Ganey Survey
%VG for Questions Within Scope
FY 09 (Q1-Q3) -Goal 75.7% (VG)
67.4%
71.5%
68.3%
Overview
Scope:
12 week pilot focused within Olson ASC Orthopaedics and ENT
specialties.
Goal Benefit:
Increase ENT and Orthopaedics scope questions by 50% VG.
Deliverables:
Electronic Discharge Instructions
Discharge Process Re-design within Olson
Discharge Phone Call Tracking
Pilot Locations
Specialties with “room” to improve PG scores
Specialties with n>30 survey response rate
Identifiable physician champion
Selection of Physician Champion
Orthopaedic Procedures within Scope
Deliverable 1:
Electronic Discharge Instructions (DI)
Risks
• Illegibility
• Static
• Lacks patient
education
• Increase in
unplanned
re-admissions
Options for the Improvement of Discharge Instructions
Electronic Discharge Instructions Implementation:
Difficulty versus Impact
Implementation Difficulty
10
Contract with
Vendor
8
Electronic
VersionPowerChart
6
4
2
Written
Instructions
0
0
2
4
Solution Impact
6
8
10
• Surgeon can
complete
instructions either
prior to or after
surgery
• Nurse prints for
review with patient
Before
After
Benefits
• Comprehensive
patient education
• Promotes
medication
compliance
• Customized per
surgeon/patient
• Reduces errors
due to illegibility
• Immediate
electronic
documentation
Recommendations: Strategically Roll-out Electronic DI
1
2
Pilot
among
MD’s
within
specific
specialty
Implement generic electronic
discharge instructions
pavilion-wide
Completed during 12 week scope
Designate specific “go-live” plan for all
pavilions
3
Customize discharge instructions by specialty
Incorporate IS and clinical staff
Recommendations: Strategically Roll-out Electronic DI
It is recommended that the Department of Surgical Services completely pilot the
EDI process within the Orthopedics specialty before moving on to ENT and
other departments. Specifically, it is recommended that additional Orthopaedics
physicians are added to the template.
At the end of the project, the electronic discharge instructions (EDI) were piloted
only within the Orthopaedics specialty. Originally, the plan was to pilot among
both Orthopaedics and ENT. During the initial roll out phase, logistical issues such
as physician training within PowerChart, physician requests for more
customization, and concerns regarding the wording of phrases delayed the ability
to roll out the process to other specialties such as ENT. In order to complete the
goal, the following steps should be taken:
Recommendations: Strategically Roll-out Electronic DI
Collection of Information
1) Identify surgeons based on case volume and procedure type. For example: include
surgeons who perform knee and shoulder arthroscopies since these procedures were
not included in the original pilot.
2) If available, collect the current (paper) discharge instructions that the surgeons give to
their patients. If pre-printed copies are not available, ask the surgeon to complete the
Ambulatory Discharge Instructions Form.
3) Look for similarities among the discharge instructions. If two or more surgeons
communicate the same message, this should be a standard prompt within the EDI
template. If only one surgeon communicates a unique message, this can be typed into the
“what” box or added specifically for the surgeon.
4) Once the discharge instructions are identified, decide under which “domain” they should
fall. For example: activity, post-operative medication, diet….
Collaborate with Information Services Documentation Specialist to have the instructions
“built” into the PowerChart note.
Recommendations: Strategically Roll-out Electronic DI
Pilot Phase
1)
Once the instructions have been added to PowerChart, select two or three days, where
a ‘trainer’ can assist the surgeon in completing the EDI. It is recommended that the
sheet entitled Process Map-Generate Discharge Instructions-MD be used for training.
2) During the phase, identify questions or concerns raised by physicians and nursing staff.
3) Using the Request to Amend Ambulatory Discharge Instructions Form, submit any
changes to the IS department.
4) Once the changes have been amended, the EDI will be ready for complete use.
Pavilion Roll-out Phase
1)
Using the above methodology, roll-out the EDI to all pavilions. In addition to the 2G
Ambulatory Ortho and ENT notes, there is also a 2G Ambulatory General note. This
note can be used as a general template for Ambulatory specialties that lack specific
customizations.
2) After physicians begin to become accustomed to the EDI, begin to add specialty specific
instructions using the process mentioned above in the “Collection of Information”
section.
Deliverable 2: Discharge Process Re-design
Olson Discharge Process Re-Design
Pre-Operative-Recommended Process
New Step
Status board
informs
PCT/RN of
patient
arrival
PCT/RN goes
to waiting
room to greet
patient and
escort back to
room
Patient
undresses and
collects
valuables in
preparation
for nursing
assessment
RN conducts
H/P, starts IV,
informs
patient of
plan and
potential
delays
RN informs
family that
they may visit
with patient
RN reviews
preliminary
discharges
instructions/
patient
education
material
Surgeon
and/or
anesthesia
may consult
prior to case
start
Patient
taken to
OR
Post-Operative-Recommended Process
New Steps
Patient
taken to
recovery
room
RN visits
patient for
post-op
assessment
Status
board is
updated
from “InOR” to
“Post-Op”
Surgeon
completes
discharge
instructions
via
PowerChart
Patient
remains
in Phase 1
until alert
Family
may visit
when
called by
nurse
RN prints
discharge
instructions
and gives to
patient in
discharge
folder
RN provides
patient
education and
manages
patient
expectations
RN
discharges
patient and
informs
patient of
follow-up
call/survey
Deliverable 3: Discharge Phone Call Tracking
Discharge Phone Call Compliance
Feinberg Discharge Phone Call Compliance
Olson Discharge Phone Call Compliance
n=76
n=76
60%
45%
40%
50%
47%
40%
32%
30%
20%
Percent of Patients Called
Percent of Patients Called
50%
40%
35%
29%
30%
25%
20%
15%
15%
10%
10%
5%
0%
0%
April
May
June
April
May
Month
Month
% Called
% Called
On average 43% of Feinberg patients
were called between April and June
June
On average 28% of Olson patients
were called between April and June
Recommendations for Increasing Discharge
Phone Call Compliance
1. Develop a monthly dashboard to track compliance rates across all pavilions
2. Set a goal of 100% follow-up phone call rate
3. Incorporate scripting at discharge: “Thank you for choosing NMH. We will be
following your care with a discharge phone call.”
4. Designate one RN the responsibility of assigning call backs
Organizational Impact of Project
Electronic Discharge Instructions
Maximization of current IT investment
Promotes provider and staff satisfaction
Competitive advantage as a Great AMC
Discharge Process Re-design within Olson
Reinforces patient education
Allows the inclusion of family members
Discharge Phone Call Tracking
Potential reduction of re-admission rates
Additional opportunity to increase patient satisfaction
Thank You
NMH Senior Leadership
Katrina Van Gerpen
Karen Anderson
Alvin dela Cruz
Michael Valitchka
Steven Thill
Ella Echavez
Surgical Services Department
Olson ASC
Dr. Armen Kelikian
Dr. Rakesh Chandra
Goran Gavran
Jennifer Bloomquist
Tia Foster
Madge Patyk
Anne Findeis
Erma Clark
Appendix of Supporting Slides
Overview
ASC Patient Satisfaction-Striving for 5's through Patient Communication
Linkage to BPE: Develop a patient experience that includes timely, consistent and accurate information regarding perioperative care for Ambulatory
Surgery Center (ASC) patients and families.
Problem: For the baseline period of Q3 FY 09, the overall average ASC patient satisfaction score was 71.4% (very good) in comparison to the overall
target of 75.7%. Press Ganey scores indicate lower patient satisfaction with 1) information received prior to surgery (67.4%), 2) information given to
the patient’s family (71.5%), and 3) instructions to patient regarding home care (68.3%).
Goal Benefit: Increase ENT and Orthopedics scope questions by 50% VG.
Scope: 12 week pilot focused within Olson ASC Orthopedics and ENT specialties. Post 12 weeks, pilot will be used as template for all NMH ASCs.
Deliverables: 1) electronic discharge instructions containing clear and effective directions for patients, 2) a pre-arrival experience providing procedure
specific patient education material and information that sets expectations for the day of surgery and home care and 3)analysis of discharge phone call
compliance
Core Team Required: Olson ASC nursing staff and registration, ENT and Orthopedics physician champion, Specialty offices, Information ServicesTechnology Management staff, Patient Education Department
Key Metric(s):
1) ASC overall average Press Ganey score
2) ENT and Orthopedics Press Ganey Scores for:
•
information you received prior to surgery
•
information given to the patient’s family
•
instructions regarding home care
3) UHC percentile rankings
Sponsor: Karen Anderson, Director-Surgical Services
Improvement Leader: Michael Valitchka
Milestones
Description
Define
Measure
Analyze
Improve
Control
Date
6/15 - 6/29
6/29 - 7/6
7/6 - 7/13
7/13 - 8/10
8/10 - 9/4
Project/Process Owner: Kelli Clifton, Graduate Administrative Intern
Project Work Plan
Project Tracking Tool
Olson ENT Volume by Physician
FY'09 (Q1-Q3)
160
18.0%
140
16.0%
14.0%
120
12.0%
80
8.0%
60
6.0%
40
4.0%
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100
Olson ENT Volume by Procedure
FY '09 (Q1-Q3)
200
25.0%
180
20.0%
Volume
140
120
15.0%
100
80
10.0%
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Key Facts
•40% of ASC patients are
surveyed
•30% response rate
•ASC surveys sent within 3
days of discharge
•Avg. Patients seen per
month
-Olson-Feinberg-Prentice•NMH reports % VG
Managing Expectations
Provider Perspective
• Patient receives appropriate
•
•
•
discharge instructions
Patient is aware of follow-up
appointments
Patient arrives on schedule for
surgery
Patient obtains accurate
diagnostic testing
Patient Perspective
• How long will I spend in the
•
•
•
ASC?
What foods/medications should
I have after surgery?
When can my family visit me in
recovery?
Why do I have to arrive earlier
than my surgery start time?
Great Academic Medical Centers with
Electronic Discharge Instructions
Olson ASC Waiting Room Process Map
ASC Waiting Room-Current Process
Patient arrives at ASC
and checks into
Receptionist desk by
giving his/her name
Receptionist pulls
patient packet and
gives to patient
Receptionist asks patient
to verify personal
information and sign
advance directives,
financial responsibility,
personal property forms
and health screening
form
Receptionist verifies
ID bracelet, places
bracelet on patient,
gives family privacy
card containing
tracking number and
validates parking
Patient told to be
seated until called by
Patient Care
Technician or nurse
ASC Waiting Room-Recommended Process
Patient arrives at ASC
and checks into
Receptionist desk by
giving his/her name
Receptionist greets
patient/family,
explains privacy
number, gives trifold,
gives information
about refreshments
location, and directs
them to ASC/Olson
Registration Area
Registration asks
patient to verify
personal information,
sign advance
directives, financial
responsibility, personal
property forms and
health screening form
Receptionist
Greet patients and family
Direct patients to Registration
Monitor status board/cases
Round throughout the area
Call interpreter services/chaplain
Direct families to hospital locations
Registration verifies
ID bracelet, places
bracelet on patient,
validates parking and
gives patient trifold to
review while waiting
Patient told to be
seated until called by
Patient Care
Technician or nurse
Registration
Staff Responsibilities
Verify patient information
Provide reference for advance directives
Validate parking
Organize patient packets
Assist receptionist with calls when available
Olson Pre-Operative Process Map
Pre-Operative-Current Process
Status board
informs
PCT/RN of
patient arrival
PCT/RN goes
to waiting
room to greet
patient and
escort back to
room
Patient is told
to undress and
collect
valuables in
preparation for
nursing
assessment
Nurse
conducts H/P
assessment,
starts IV,
informs patient
of plan and
potential
delays
Nurse informs
family that
they may visit
with patient
Surgeon
and/or
anesthesia
may consult
prior to case
start
Patient taken
to OR
Pre-Operative-Recommended Process
Status board
informs
PCT/RN of
patient arrival
PCT/RN goes
to waiting
room to greet
patient and
escort back to
room
Patient is told
to undress and
collect
valuables in
preparation for
nursing
assessment
Nurse
conducts H/P
assessment,
starts IV,
informs patient
of plan and
potential
delays
New Steps
If completed,
RN reviews
preliminary
discharges
instructions/
patient
education
material
Nurse informs
family that
they may visit
with patient
Surgeon
and/or
anesthesia
may consult
prior to case
start
Patient
taken to
OR
Olson Post-Operative Process Map
Post-Operative-Current Process
Patient taken
from OR to
recovery room
by anesthesia
team
RN visits
patient for
post-operative
assessment
Status board is
updated from
“In-OR” to
“Post-Op”
Patient
remains in
Phase 1 until
alert
Family may
visit when
called by nurse
Nurse goes
over discharge
instructions
from physician
Patient
discharged
from ASC
Post-Operative-Recommended Process
Patient
taken from
OR to
recovery
room by
anesthesia
team
RN visits
patient for
postoperative
assessment
Status
board is
updated
from “InOR” to
“Post-Op”
Surgeon
complete
discharge
instructions
via
PowerChart
Patient
remains in
Phase 1
until alert
New Step
Family
may visit
when
called by
nurse
Nurse prints
completed
discharge
instructions
and gives to
patient in
discharge
folder
Nurse
provides
patient
education and
manages
patient
expectations
Nurse
discharges
patient and
informs patient
of follow-up
call/survey
Discharge Instructions for Medical Staff
Log into Power Chart
Select patient from patient list or by
medical record number
Select Notes 2G Tab and then ADD to
generate discharge note
Select Encounter Pathway tab, search for
note…..Ex. 2G Ambulatory Ortho
Click note name to highlight and “Add to
Favorites” for quick accessibility
Double click on note name to open and
generate discharge instructions
Click hide structure or show structure to
select instructions or preview document
When complete, sign note by selecting
‘Discharge Instructions” as the Type
Discharge Instructions for Nursing Staff
Log into Surginet
Select patient from patient list or by medical record number
Select Reports and Summaries
Select Specific Discharge Summary
Print Discharge Instructions for Patient
Updating PowerChart Discharge Instructions
If you need to update information within the discharge instructions….
Use the Request to Amend form and send to IS for assistance