TL13EOc
Visibility, Accessibility, and Communication TL13EO
Using the required empirical outcomes (EO) presentation format, provide one example of an improvement in patient care or the nurse practice environment, associated with communication between the clinical nurse(s) and a Nurse Manager.
Example c: Nurse Manager Communicating with Clinical Nurses Results in Increased Patient Experience Scores
Problem
The Emergency Department (ED) at Catholic Health Initiatives (CHI) St. Vincent Hot Springs (SVHS) had lower than desired patient experience scores for the survey item, “Nurses took time to listen.”
Pre-Intervention
Renee Fechuch, MSN, RN, Clinical Director of Nursing, met with Tanner Ross, BSN, RN, ED Nurse Manager, to discuss low Press Ganey (PG) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) top box patient experience scores. In February 2024, the CHI SVHS ED top box percentage for the survey item, “Nurses took time to listen” was 55.14%.
The ED patient care coordinators (PCC) met at the end of February 2024. (All PCCs are clinical nurses.) Ross communicated to the PCCs the current PG HCAHPS patient experience scores for February, including the score for “Nurses took time to listen.” The clinical nurses in the PCC role in the ED include Andrew Terauchi, BSN, RN; Cayleb Meeks, RN; Sama Lea Holt, RN; and Carmelita Chavez, BSN, RN. Ross asked the PCCs for input into how to improve this score, knowing that the PCCs’ engagement in a solution would promote success for the team as a whole. Ross shared that he and Fechuch were conducting daily Leader Rounds with a focus on patients who are being admitted. Terauchi noted that the patients who receive surveys are those discharged from the ED, so the leaders should change their focus. Ross agreed with this while also noting that all patients need to be rounded on.
Ross and the PCCs communicated to develop a plan that involved each PCC rounding each shift on five ED patients who are being discharged home. Ross, Fechuch, and Angela Burton, BSN, RN, Clinical Nurse/Nurse Supervisor, would round on all patients being admitted to the hospital from the ED and being discharged home from the ED.
Ross and the PCCs discussed the processes that needed to be in place for rounding. The group looked at the questions to ask when rounding and adopted those used in leader rounding, including:
- Can you share with me what our team has explained to you about your plan of care?
- With our frequent rounding and checks, how are we doing at meeting your needs?
- Talk to me about what the staff has taught you about your medication side effects?
- Do you have the help you need to care for yourself at home?
- Is there anyone in particular who has gone the extra mile?
- Is there anything I can do for you or get for you before I leave, I have the time?
Ross and the PCCs decided to implement a rounding log to track who had been rounded on. The rounding log would include the date, a patient sticker (name, date of birth, hospital number), good feedback or feedback on any issue to follow up on or needing service recovery, recognitions for any team members who cared for them, and the PCC’s initials. The group decided that any issues or concerns would be addressed in real time to improve the patient experience, which should be reflected in improved PG HCAHPS patient experience scores. If the PCCs encountered issues that they needed assistance with resolving, they would escalate these to Ross or to the house supervisor when Ross was unavailable. The log would enable the team to track all trends in feedback.
Goal Statement
Improve the CHI SVHS ED PG HCAHPS top box percent for the item, “Nurses took time to listen.”
Participants
ED Patient Experience Work Group
|
|||
Name/Credentials |
Discipline |
Title/Role |
Department |
Renee Fechuch, MSN, RN |
Nursing |
Clinical Director of Nursing |
Nursing Administration |
Tanner Ross, BSN, RN |
Nursing |
Nurse Manager |
Emergency Department |
Angela Burton, BSN, RN |
Nursing |
Nurse Supervisor/ |
Emergency |
Andrew Terauchi, BSN, RN |
Nursing |
Patient Care Coordinator/ Clinical Nurse |
Emergency Department |
Cayleb Meeks, RN |
Nursing |
Patient Care Coordinator/ Clinical Nurse |
Emergency Department |
Sama Lea Holt, RN |
Nursing |
Patient Care Coordinator/ |
Emergency Department |
Carmelita Chavez, BSN, RN |
Nursing |
Patient Care Coordinator/ Clinical Nurse |
Emergency Department |
Description of the Intervention
March 2024
- Ross created the patient experience/rounding log. This paper log was kept at the charge nurse desk for all PCCs, Burton, Ross, and Fechuch to use daily.
- All clinical nurse PCCs started rounding on five ED patients per shift using the agreed upon questions.
- All PCCs, Fechuch, Ross, and Burton addressed any patient concerns in real time.
- Ross reported out leader rounding numbers and recognitions at the hospital-wide daily experience huddle, attended by all leaders.
The interventions were fully implemented by March 2024.
ED Clinical Nurse PCC communication with Nurse Manager Ross was associated with the improved outcome of an increase in the PG HCAHPS top box score for “Nurses took time to listen.” The enhanced leader rounding included patients being discharged from the ED who provide feedback through the PG survey. The enhanced leader rounding ensured ED patients were connected with nurses (the manager or PCC) who took the time to listen and address concerns before their discharge from the ED.
References
McFarlan, S., O’Brien, D., & Simmons, E. (2019). Nurse-Leader Collaborative Improvement Project: Improving Patient Experience in the emergency department. Journal of Emergency Nursing, 45(2), 137–143. https://doi.org/10.1016/j.jen.2018.11.007
Thew, J. (2019). Hone Nurse Listening Skills For Better Patient Experience. HealthLeaders Media. https://www.healthleadersmedia.com/nursing/hone-nurse-listening-skills-better-patient-experience
Outcome
(Evidence TL13EOc-1, CHI SVHS ED - PG HCAHPS Top Box Percent Nurses Took Time to Listen)