Introduction: The patient’s experience has become a key quality measure for hospitals. The Hospital Consumer Assessment of Healthcare Provider and Systems (HCAHPS) patient satisfaction survey has been adopted by Center for Medicare/Medicaid Services as a tool to guide hospital evaluations, improve patient decision-making, and financially incentivize hospitals to provide high-quality care. Understanding the factors that influence patients’ perception of their care is critical for making systematic steps to improve this quality measure.
Methods: Anecdotally, many providers believe that the patient experience suffers with a heavy inpatient census, resulting in increased workload for physicians, trainees, nurses, and ancillary staff. From 2010-2014, HCAHPS survey results for the neurosurgery service at University of California, San Francisco were collected and compiled by quarter. The average daily inpatient census (ADC) on the neurosurgery service for the same period was also recorded.
Results: ADC on the neurosurgery service ranged from 41 to 54 patients. A lower census was significantly associated with higher overall ratings of the hospital and higher likelihood to recommend the hospital. A lower census was associated with higher likelihood to answer “always” to the questions, “how often did nurses listen carefully to you”, and “after you pressed the call button, how often did you get help as soon as you wanted it”. There was no correlation between census and survey answers regarding care from physicians.
Conclusions: In an academic medical center, patients provide higher ratings of the hospital overall when patient census is low. This may be influenced by the perception that nursing care is better on low census days. Their perception of the quality of care provided by physicians did not seem to change with the inpatient volume. Our results suggest the need for a more vigilant approach for maintaining optimal nursing:patient ratios during times of high inpatient census.
Patient Care: The patient's perception of the care they receive has been become a key measure of care quality. In this study, by identifying situations that are associated with higher or lower satisfaction scores, we are able to guide future quality improvement efforts. In addition, as reimbursement becomes increasingly tied to patient satisfaction scores, studies such as ours allow clinicians and hospitals to develop greater awareness of the key role quality improvement plays in our daily practice.
Learning Objectives: By the conclusion of the session, participants should be able to:
1) Describe the elements to the HCAHPS survey
2) Describe the potential impact of hospital volume on the patient experience
3) Discuss potential methods to improving the patient hospital experience