The impact of facecards on patients' knowledge, satisfaction, trust, and agreement with hospital physicians: a pilot study

The Effect of Standardized Hospitalist Information Cards on the Patient Experience: a Quasi-Experimental Prospective Cohort Study

BACKGROUND

Communication with clinicians is an important component of a hospitalized patient's experience.

OBJECTIVE

To test the impact of standardized hospitalist information cards on the patient experience.

DESIGN

Quasi-experimental study in a U.S. tertiary-care center.

PARTICIPANTS

All-comer medicine inpatients.

INTERVENTIONS

Standardized hospitalist information cards containing name and information on a hospitalist's role and availability vs. usual care.

MAIN MEASURES

Patients' rating of the overall communication as excellent ("top-box" score); qualitative feedback summarized via inductive coding.

KEY RESULTS

Five hundred sixty-six surveys from 418 patients were collected for analysis. In a multivariate regression model, standardized hospitalist information cards significantly improved the odds of a "top-box" score on overall communication (odds ratio: 2.32; 95% confidence intervals: 1.07-5.06). Other statistically significant covariates were patient age (0.98, 0.97-0.99), hospitalist role (physician vs. advanced practice provider, 0.56; 0.38-0.81), and hospitalist-patient gender combination (female-female vs. male-male, 2.14; 1.35-3.40). Eighty-seven percent of patients found the standardized hospitalist information cards useful, the perceived most useful information being how to contact the hospitalist and knowing their schedule.

CONCLUSIONS

Hospitalized patients' experience of their communication with hospitalists may be improved by using standardized hospitalist information cards. Younger patients cared for by a team with an advanced practice provider, as well as female patients paired with female providers, were more likely to be satisfied with the overall communication. Assessing the impact of information cards should be studied in other settings to confirm generalizability.

Improving patients' ability to identify their physicians through the use of physician facecards and whiteboards

Background

Hospitalised patients are often not able to correctly identify members of their physician team. Identifying physicians is a critical component of developing the patient–physician relationship and visual aids have been shown to improve physician identification and overall patient satisfaction.

Objectives

The aim of this quality improvement study was to assess the impact of implementation of a physician facecard on the ability of patients to identify their attending physician and other members of the physician team, as well as to evaluate current use of patient whiteboards for physician team identification.

Methods

We prospectively studied 149 patients admitted to the medicine teaching service, who were randomised to receive a physician facecard or usual care. Patients were surveyed to determine their ability to identify physician team members. Observational data was also collected regarding use of patient whiteboards. Additionally, all hospitalists were surveyed to assess their perception of these visual aids.

Results

Patients who received the facecard were more likely to recall the name of the attending physician as compared with the control group (63% vs 32%, p<0.01). Additionally, 68% of patients with the attending name correctly listed on their whiteboard were able to correctly identify the attending physician (p<0.01). Ninety per cent of patients who both received a facecard and had their whiteboard correctly filled out were able to identify the attending physician. Eighty per cent of hospitalists surveyed agreed that use of the facecard added value and 90% disagreed that routine use of the facecard was burdensome.

Conclusion

The use of physician facecards improves the ability of hospitalised patients to identify their attending physicians, and the combined use of facecards and whiteboards may provide additive benefits.

Impact of a Resident-Guided Rounding Initiative on the Hospital Consumer Assessment of Healthcare Providers and Systems Survey Scores in Orthopaedic Surgery Inpatients

Patient-centered medicine is becoming the main focus of many healthcare systems, and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a tool used to track patient satisfaction. In this study, we evaluate the HCAHPS scores in orthopaedic surgery inpatients before and after implementation of a resident-guided rounding protocol. Analyses of the HCAHPS surveys for 154 orthopaedic surgical inpatients at one community hospital were compared 6 months before and after implementation of a resident-guided rounding initiative. Specific questions of the HCAHPS survey were analyzed using the top box, mean, and positive scores. Implementation of the rounding initiative resulted in an increase in the top box, mean, and positive scores for all questions evaluated; however, no significance was noted in the results, with the exception of the positive score for a staff cohesiveness question (P = 0.046). Physician and hospital recommendation questions showed a 5-point increase (91st to 96th percentile) compared with 42-point increase (21st to 63rd percentile) by publicly reported national data. Implementation of the rounding initiative resulted in increases in HCAHPS scores across multiple questions and domains; however, these were not significant. These results suggest that simple interventions can help increase the overall patient satisfaction and promote future investigations.

Novel approach to improve patient satisfaction in the outpatient clinic setting

BACKGROUND

With evolving reimbursement patterns and an emphasis on value-based care, patient satisfaction is increasingly becoming a more important metric. However, there remains a dearth of literature examining potential strategies to improve patient satisfaction in the outpatient setting. This study investigates if overall perception of care is influenced by providing biosketch cards to new patients in an outpatient Sports Medicine clinic.

METHODS

144 new patients were assigned to an intervention group based on the date of visit from 3/2017 to 8/2017. Eligible patients received a treating physician biosketch card (Group A), clinical practice biosketch card (Group B) or no additional literature (Control group) during the clinic check-out process. Via email, patients were asked to rate: 1- quality of care, 2- treated with courtesy and respect, 3- listened to carefully, 4- was explained things in a way you could understand, 5- overall rating, 6- recommend to family and friend? We also collected age, gender, level of education, and response time. The three groups were compared.

RESULTS

96 (66.7%) patients responded with 32 patients in each group (physician biosketch, clinic biosketch, no intervention). There were no significant demographic differences between the groups. The average age was 51.8 years with 52% being male. Mean time from visit to response was 1.6 days. The only significant difference occurred for rating "how would you rate your orthopedic doctor with treating you with courtesy and respect?", however, post hoc analysis failed to reveal a significant difference in response between each study group. There was no statistical difference between the remaining questions on patient satisfaction.

CONCLUSION

Increasing a new patient's awareness, via physician or clinic information sheets, has no added benefit for patient satisfaction in the outpatient sports medicine setting.

The impact of spine disease, relative to cranial disease, on perception of health and care experience: an analysis of 1484 patients in a tertiary center

OBJECTIVEPatient-reported outcomes have been increasingly mandated by regulators and payers to evaluate hospital and physician performance. The purpose of this study is to delineate the differences in patient-reported experience of hospital care for cranial and spinal operations.METHODSThe authors selected all patients who underwent inpatient, elective cranial or spinal procedures and completed the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey at a single, high-volume, tertiary care institution between October 2012 and September 2015. The association of the surgical procedure and diagnosis with various HCAHPS composite measures, calculated across 9 domains using standard top-box methodology, was investigated. Multivariable logistic regression models were fitted for outcomes that were significant with procedure type and diagnosis group on univariate analysis, adjusting for age, sex, case complexity, overall health rating, and education level.RESULTSA total of 1484 patients met criteria and returned an HCAHPS survey. Overall, patients undergoing a cranial procedure gave top-box (most favorable) scores more often in pain management measure (66.3% vs 59.6%, p = 0.01) compared with those undergoing spine surgery. Furthermore, despite better discharge scores (93.1% vs 87.1%, p < 0.001), spinal patients were less likely to report excellent health (7.4% vs 12.7%). Lastly, patients with a primary diagnosis of brain or spinal tumor compared with those with degenerative spinal disease and those with other neurosurgical diagnoses provided top-box scores more often regarding communication with doctors (82.7% vs 76.4% vs 75.2%, p = 0.04), pain management (71.8% vs 60.9% vs 59.1%, p = 0.002), and global rating (90.4% vs 84.0% vs 87.3%, p = 0.02). On multivariable analysis, spinal patients had significantly lower odds of reporting top-box scores in pain management (OR 0.67, 95% CI 0.52-0.85; p = 0.001), staff responsiveness (OR 0.68, 95% CI 0.53-0.87; p = 0.002), and global rating (OR 0.59, 95% CI 0.42-0.82; p = 0.002), and significantly higher odds of top-box scoring in discharge information (OR 2.15, 95% CI 1.45-3.18; p < 0.001) than cranial patients. Similarly, brain tumor cases were associated with significantly higher odds of top-box scoring in communication with doctors (OR 1.46, 95% CI 1.01-2.12; p = 0.04), pain management (OR 1.81, 95% CI 1.29-2.55; p < 0.001), staff responsiveness (OR 1.88, 95% CI 1.33-2.66; p < 0.001), and global rating (OR 2.00, 95% CI 1.26-3.17; p = 0.003) compared with degenerative spine cases.CONCLUSIONSSignificant differences in patient-reported experience with hospital care exist across different cranial and spine surgery patient populations. Overall, spinal patients, particularly those with degenerative spine disease, rated their health and their hospital experience lower relative to cranial patients. Identifying weaker areas of hospital performance in target populations can stimulate quality initiatives that aim to increase the overall hospital score.

Do Bedside Visual Tools Improve Patient and Caregiver Satisfaction? A Systematic Review of the Literature

BACKGROUND

Although common, the impact of low-cost bedside visual tools, such as whiteboards, on patient care is unclear.

PURPOSE

To systematically review the literature and assess the influence of bedside visual tools on patient satisfaction.

DATA SOURCES

Medline, Embase, SCOPUS, Web of Science, CINAHL, and CENTRAL.

DATA EXTRACTION

Studies of adult or pediatric hospitalized patients reporting physician identification, understanding of provider roles, patient-provider communication, and satisfaction with care from the use of visual tools were included. Outcomes were categorized as positive, negative, or neutral based on survey responses for identification, communication, and satisfaction. Two reviewers screened studies, extracted data, and assessed the risk of study bias.

DATA SYNTHESIS

Sixteen studies met the inclusion criteria. Visual tools included whiteboards (n = 4), physician pictures (n = 7), whiteboard and picture (n = 1), electronic medical record-based patient portals (n = 3), and formatted notepads (n = 1). Tools improved patients' identification of providers (13/13 studies). The impact on understanding the providers' roles was largely positive (8/10 studies). Visual tools improved patient-provider communication (4/5 studies) and satisfaction (6/8 studies). In adults, satisfaction varied between positive with the use of whiteboards (2/5 studies) and neutral with pictures (1/5 studies). Satisfaction related to pictures in pediatric patients was either positive (1/3 studies) or neutral (1/3 studies). Differences in tool format (individual pictures vs handouts with pictures of all providers) and study design (randomized vs cohort) may explain variable outcomes.

CONCLUSION

The use of bedside visual tools appears to improve patient recognition of providers and patient-provider communication. Future studies that include better design and outcome assessment are necessary before widespread use can be recommended.

Interventions to improve hospital patient satisfaction with healthcare providers and systems: a systematic review

BACKGROUND

Many hospital systems seek to improve patient satisfaction as assessed by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. A systematic review of the current experimental evidence could inform these efforts and does not yet exist.

METHODS

We conducted a systematic review of the literature by searching electronic databases, including MEDLINE and EMBASE, the six databases of the Cochrane Library and grey literature databases. We included studies involving hospital patients with interventions targeting at least 1 of the 11 HCAHPS domains, and that met our quality filter score on the 27-item Downs and Black coding scale. We calculated post hoc power when appropriate.

RESULTS

A total of 59 studies met inclusion criteria, out of these 44 did not meet the quality filter of 50% (average quality rating 27.8%±10.9%). Of the 15 studies that met the quality filter (average quality rating 67.3%±10.7%), 8 targeted the Communication with Doctors HCAHPS domain, 6 targeted Overall Hospital Rating, 5 targeted Communication with Nurses, 5 targeted Pain Management, 5 targeted Communication about Medicines, 5 targeted Recommend the Hospital, 3 targeted Quietness of the Hospital Environment, 3 targeted Cleanliness of the Hospital Environment and 3 targeted Discharge Information. Significant HCAHPS improvements were reported by eight interventions, but their generalisability may be limited by narrowly focused patient populations, heterogeneity of approach and other methodological concerns.

CONCLUSIONS

Although there are a few studies that show some improvement in HCAHPS score through various interventions, we conclude that more rigorous research is needed to identify effective and generalisable interventions to improve patient satisfaction.

Parents reported higher satisfaction rates when children recognised hospital staff from photographs placed in prominent locations

AIM

Improved communication with staff during a child's hospitalisation is an important determinant of family satisfaction. We examined whether displaying staff photographs in prominent locations would help children and their parents or guardians to recognise staff and whether this enhanced identification would improve parental satisfaction with their child's hospitalisation.

METHODS

No photographs were displayed during the first part of the study. During the second part of the study, staff photographs were placed in prominent locations throughout the paediatric ward. Parents filled in a satisfaction questionnaire on discharge, and the children and their parents were asked how many staff members they could name.

RESULTS

The children named a significantly larger number of staff members in phase two than phase one, while the parents' score was unchanged. Overall parental satisfaction was significantly higher in phase two. The parent's age, the duration of the child's hospitalisation and taking part in phase two of the study were significant predictors of parental satisfaction.

CONCLUSION

When children were more able to recognise and name hospital staff, this indirectly improved parental satisfaction, even if the number that parents could identify remained unchanged. Displaying staff photographs is a simple way of increasing parental satisfaction during a child's hospitalisation.

Faces of all clinically engaged staff: a quality improvement project that enhances the hospitalised patient experience

BACKGROUND

Patients often cannot recognise the names and faces of providers involved in their hospital care.

OBJECTIVE

The aim of this study was to determine whether photographs of a patient's providers (physicians and ancillary support staff) using the FACES (Faces of All Clinically Engaged Staff) instrument would increase recognition of the healthcare team, improve the perception of teamwork, and enhance patient satisfaction.

METHODS

Cluster randomised controlled trial with patients admitted to four adult internal medicine services of an urban, tertiary care hospital. Patients randomly admitted to two services received the FACES instrument, while the remainder served as control. Study measurements included the proportion of patients able to recognise their care providers by photograph, name and role, as well as patient rating of communication among healthcare team members and their satisfaction with the hospital experience as assessed by a survey.

RESULTS

A total of 197 of the 322 (61.2%) patients screened for participation proved eligible for the study. Key exclusion criteria included cognitive or visual impairment and non-fluency with English. Patients receiving the FACES instrument recognised more provider names, faces and roles than controls (all P<.001). The intervention group more strongly agreed with statements that healthcare providers communicated frequently and effectively with each other (68% vs 52%, P=.02), and worked well together (69% vs 53%, P=.02). When rating their satisfaction with the hospital experience, 50% of patients in the intervention group assigned the highest possible rating, compared with 36% of control (P=.06).

LIMITATIONS

Nursing staff, although integral to healthcare teams, were not included in the FACES instrument due to privacy concerns.

CONCLUSIONS

The FACES instrument improved patients' recognition of providers' names and roles, as well as patients' perception of inter-provider teamwork. There was a non-significant trend towards improved satisfaction.

Doctor Who? A Quality Improvement Project to Assess and Improve Patients' Knowledge of Their Inpatient Physicians

Background Patient-physician communication is an integral part of high-quality patient care and an expectation of the Clinical Learning Environment Review program. Objective This quality improvement initiative evaluated the impact of an educational audit and feedback intervention on the frequency of use of 2 tools-business cards and white boards-to improve provider identification. Methods This before-after study utilized patient surveys to determine the ability of those patients to name and recognize their physicians. The before phase began in July 2013. From September 2013 to May 2014, physicians received education on business card and white board use. Results We surveyed 378 patients. Our intervention improved white board utilization (72.2% postintervention versus 54.5% preintervention, P < .01) and slightly improved business card use (44.4% versus 33.7%, P = .07), but did not improve physician recognition. Only 20.3% (14 of 69) of patients could name their physician without use of the business card or white board. Data from all study phases showed the use of both tools improved patients' ability to name physicians (OR = 1.72 and OR = 2.12, respectively; OR = 3.68 for both; P < .05 for all), but had no effect on photograph recognition. Conclusions Our educational intervention improved white board use, but did not result in improved patient ability to recognize physicians. Pooled data of business cards and white boards, alone or combined, improved name recognition, suggesting better use of these tools may increase identification. Future initiatives should target other barriers to usage of these types of tools.

Care team identification in the electronic health record: A critical first step for patient-centered communication

Patient-centered communication is essential to coordinate care and safely progress patients from admission through discharge. Hospitals struggle with improving the complex and increasingly electronic conversation patterns among care team members, patients, and caregivers to achieve effective patient-centered communication across settings. Accurate and reliable identification of all care team members is a precursor to effective patient-centered communication and ideally should be facilitated by the electronic health record. However, the process of identifying care team members is challenging, and team lists in the electronic health record are typically neither accurate nor reliable. Based on the literature and on experience from 2 initiatives at our institution, we outline strategies to improve care team identification in the electronic health record and discuss potential implications for patient-centered communication. Journal of Hospital Medicine 2016;11:381-385. © 2016 Society of Hospital Medicine.

Measuring patient experiences on hospitalist and teaching services: Patient responses to a 30-day postdischarge questionnaire

BACKGROUND

Data comparing patient experiences between general medicine teaching and nonteaching hospitalist services are lacking.

OBJECTIVE

Evaluate hospitalized patients' experience on general medicine teaching and nonteaching hospitalist services by assessing patients' confidence in their ability to identify their physician(s), understand their roles, and their rating of the coordination and overall care.

METHODS

Retrospective cohort analysis of general medicine teaching and nonteaching hospitalist services from 2007 to 2013 at an academic medical center. Patients were surveyed 30-days after hospital discharge regarding their confidence in their ability to identify their physician(s), understand the role of their physician(s), and their perceptions of coordination and overall care. A 3-level, mixed effects logistic regression was performed to ascertain the association between service type and patient-reported outcomes.

RESULTS

Data from 4591 general medicine teaching and 1811 nonteaching hospitalist service patients demonstrated that those cared for by the hospitalist service were more likely to report being able to identify their physician (50% vs 45%, P < 0.001), understand their role (54% vs 50%, P < 0.001), and rate greater satisfaction with coordination (68 vs 64%, P = 0.006) and overall care (73% vs 67%, P < 0.001). In regression models, the hospitalist service was associated with higher ratings in overall care (odds ratio [OR]: 1.33; 95% confidence interval [CI]: 1.15-1.47), even when hospitalists were the attendings on general medicine teaching services (OR: 1.17; 95% CI: 1.01-1.31).

CONCLUSION

Patients on a nonteaching hospitalist service rated their overall care slightly better than patients on a general medicine teaching service. Team structure and complexity may play a role in this difference.

The impact of a patient education bundle on neurosurgery patient satisfaction

Background:

As reimbursements and hospital/physician performance become ever more reliant on Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) and other quality metrics, physicians are increasingly incentivized to improve patient satisfaction.

Methods:

A faculty and resident team at the University of California, San Francisco (UCSF) Department of Neurological Surgery developed and implemented a Patient Education Bundle. This consisted of two parts: The first was preoperative expectation letters (designed to inform patients of what to expect before, during, and after their hospitalization for a neurosurgical procedure); the second was a trifold brochure with names, photographs, and specialty/training information about the attending surgeons, resident physicians, and nurse practitioners on the neurosurgical service. We assessed patient satisfaction, as measured by HCAHPS scores and a brief survey tailored to our specific intervention, both before and after our Patient Education Bundle intervention.

Results:

Prior to our intervention, 74.6% of patients responded that the MD always explained information in a way that was easy to understand. After our intervention, 78.7% of patients responded that the MD always explained information in a way that was easy to understand. “Neurosurgery Patient Satisfaction survey” results showed that 83% remembered receiving the preoperative letter; of those received the letter, 93% found the letter helpful; and 100% thought that the letter should be continued.

Conclusion:

Although effects were modest, we believe that patient education strategies, as modeled in our bundle, can improve patients’ hospital experiences and have a positive impact on physician performance scores and hospital ratings.

The effect of tablet computers with a mobile patient portal application on hospitalized patients' knowledge and activation

OBJECTIVE

To assess the effect of tablet computers with a mobile patient portal application on hospitalized patients' knowledge and activation.

METHODS

We developed a mobile patient portal application including pictures, names, and role descriptions of team members, scheduled tests and procedures, and a list of active medications. We evaluated the effect of the application using a controlled trial involving 2 similar units in a large teaching hospital. Patients on the intervention unit were offered use of tablet computers with the portal application during their hospitalization. We assessed patients' ability to correctly name their nurse, primary service physicians, physician roles, planned tests and procedures, medications started, and medications stopped since admission. We also administered the Short Form of the Patient Activation Measure.

RESULTS

Overall, 100 intervention- and 102 control-unit patients participated. A higher percentage of intervention-unit patients correctly named ≥1 physician (56% vs 29.4%; P < .001) and ≥1 physician role (47% vs 15.7%; P < .001). Knowledge of nurses' names, planned tests, planned procedures, and medication changes was generally low and not significantly different between the study units. The Short Form of the Patient Activation Measure mean (SD) score was also not significantly different at 64.1 (13.4) vs 62.7 (12.8); P = .46.

CONCLUSIONS

Additional research is needed to identify optimal methods to engage and inform patients during their hospitalization, which will improve preparation for self- management after discharge.

Position of the physician's nametag--a randomized, blinded trial

Background

The patient-physician relation begins when the physician introduces himself with name and function. Most institutions request a nametag with name and function to be worn. Although nametags are consequently worn, the optimal position for the nametag is unknown. It was the purpose of this study to identify whether positioning the nametag on the right or the left chest side provides better visibility to the patient.

Method and Material

One hundred volunteers, blinded to the experimental setup, presented for an orthopedic consultation in a standardized manner. The nametag of the physician was randomly positioned on the left chest side and presented to 50 individuals (age 35 years (range 17 to 83)) or the right chest side and then presented to 50 other individuals (35 years (range 16 to 59)). The time of the participant noticing the nametag was documented. Subsequently, the participant was questioned concerning the relevance of a nametag and verbal self-introduction of the physician.

Results

38% of the participants noticed the nametag on the right as opposed to 20% who noticed it if placed on the left upper chest (p = 0.0473). The mean time to detection was 9 (range 1–40) seconds for nametags on the right and 25.2 seconds (range 3 to 49, p = 0.006) on the left. For 87% of the participants, a nametag is expected and important and nearly all participants (96%) expected the physician to introduce himself verbally.

Conclusion

It is expected that a physician wears a nametag and introduce himself verbally at the first encounter. Positioning the nametag on the right chest side results in better and faster visibility.

Put a face to a name: a randomized controlled trial evaluating the impact of providing clinician photographs on inpatients' recall

BACKGROUND

Inpatients are visited by many health care providers daily; many cannot remember the name of even one member of their clinical care team. We provided inpatients with photographs of their clinicians and evaluated the impact on patient recall and communication with their health care providers.

METHODS

A concealed allocation, randomized controlled trial (ClinicalTrials.gov NCT01658644) was conducted between September 2012 and April 2013 in the general internal medicine wards of a large teaching hospital in Toronto, Canada. Consenting patients were randomized into 3 groups: the control group received the current standard of care; the second group received handouts with the names and roles of their clinical care team; and the third group received handouts with the names, roles, and photographs of their clinical care team. Before discharge, patients completed a survey on their ability to recall their clinicians and were asked to rate the quality of communication with their care team.

RESULTS

Of the 186 patients (mean age 61 years, female = 44%) who completed surveys (control n = 60; names n = 65; photos n = 61), those receiving photos in the handout correctly identified significantly more clinicians by photograph (P = .001) and recalled more names (P = .002) than patients assigned to the control group. Regarding the perceived quality of communication, the results did not show differences between the control and intervention groups.

CONCLUSION

In this era of patient-centered care, providing patients with more information about who is directly involved with their health care appears to be warranted.

What do hotels and hospitals have in common? How we can learn from the hotel industry to take better care of patients

Despite widely divergent public perceptions and goals, hotels and hospitals share many core characteristics. Both serve demanding and increasingly well-informed clienteles, both employ a large hierarchy of workers with varying levels of responsibility, and both have payments that are increasingly tied to customer/patient evaluations. In the hotel industry, decades of management experience and market research have led to widespread improvements and innovations that improve customer satisfaction. But there has been incredibly little cross-fertilization between the hotel and hospital industries. In this paper, we first consider the changes in the healthcare system that are forcing hospitals to become more concerned with patient satisfaction. We discuss the similarities and differences between the hotel and hospital industries, and then outline several of the unique challenges that neurosurgeons face in taking care of patients and increasing their comfort. We cite specific lessons from the hotel industry that can be applied to patients’ preadmission, check-in, hospital stay, discharge planning, and poststay experiences. We believe that hospitals can and should leverage the successful advances within the hotel industry to improve patient satisfaction, without having to repeat identical research or market experimentation. We hope this will lead to rapid improvements in patient experiences and overall wellbeing.