St. Joseph’s Hospital Improves Patient Safety Using AHRQ Tools
St. Joseph's Hospital, a 72-bed facility in Breese, Illinois, has improved care and increased satisfaction among patients by using three evidence-based resources from AHRQ:
- The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS®), a standardized survey that measures patients' perspectives about their care.
- The Re-Engineered Discharge (RED) Toolkit, a discharge planning resource to help patients prepare for life at home after hospitalization with information about medications and follow-up appointments.
- The Medications at Transitions and Clinical Handoffs (MATCH) toolkit, which identifies discrepancies between a patient's current medications and a physician's admission, transfer, and/or discharge orders
"Our hospital began implementing the HCAHPS survey in 2010 to improve three key measures: response of hospital staff, communication with doctors, and discharge information," said Jan Robert, R.N., B.S.N., St. Joseph's director of quality management.
The hospital's 2014 overall survey rating was in the 98th percentile, an improvement from the 94th percentile in 2010, "We made tremendous improvement," added Ms. Robert.
To address the "response of hospital staff" measure, St. Joseph's developed diverse strategies. Nurses began structured, purposeful visits to patients. The hospital implemented a non-punitive system to monitor nurses' locations and the frequency of their patient visits. Staff were told how St. Joseph's HCAHPS survey scores compared with other facilities. As a result, one unit developed an improved workflow system. Regular "improvement sessions" using HCAHPS survey results have helped assess system changes.
For the "communication with doctors" measure, the hospital began using HCAHPS survey scores to develop reports posted weekly near the physician's lounge. Physicians learn how their scores compare with others. "We emphasize transparency; using visual strategies helps physicians improve their encounters with patients and families," Ms. Robert noted.
Finally, to address the measure related to improving patient discharges, the hospital used AHRQ's RED toolkit to support patients who had been treated for congestive heart failure, pneumonia, and chronic obstructive pulmonary disease admissions.
"Using the RED toolkit, we walked through each step of the process, including medication reconciliation," said Ms. Robert.
Each patient now receives an after-hospital care plan. Trained "discharge advocates" make three or more post-discharge phone calls to patients. Follow-up physician appointments are scheduled prior to discharge. When patients are readmitted, each case is reassessed for improvement opportunities.
Ms. Robert said St. Joseph also affirmed the importance of establishing continuity with local community agencies. "We found that nursing homes and assisted living facilities were struggling to get the education they needed, so a local community college stepped in and conducted training for them. As a result, heart failure rate readmissions were reduced from 10 percent to zero," she said.
In addition to those improvements, the hospital has used AHRQ's MATCH toolkit to improve medication reconciliation.
"Although the overall process for medication reconciliation was very good, we frequently worked with incorrect information from the home medication list, and these errors would flow downstream," said Joel Tucker, Pharm.D., director of the pharmacy. During a two-month study, the pharmacy corrected 2.3 errors per patient.
St. Joseph's Hospital, a not-for-profit facility, serves about 37,000 residents and provides obstetric services to five counties.
