Executive Summary
Despite time constraints and other pressures, emergency personnel can improve both outcomes and patient satisfaction by taking the time to engage patients in decisions about their care, according to Leana Wen, MD, MSc, an emergency medicine physician and the director of Patient-Centered Care Research at George Washington University in Washington, DC. Wen has written a book aimed at helping patients advocate for themselves, but she also notes that many emergency providers could be doing a better job of asking patients about their concerns.
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Wen advises nurses and other emergency staff to prompt patients to organize their thoughts and prepare questions while they are waiting to see the provider.
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She also urges providers to explain to patients why they are doing certain tests or procedures. This can help providers avoid unnecessary steps, and to formulate a better plan of care.
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With respect to patient satisfaction, Wen acknowledges that some patients may not be happy when they are denied antibiotics or other care that they are requesting, but she notes that such concerns are usually assuaged when providers take the time to explain why the requested test or prescription is not advisable.
Hospitals now have new options to consider in the way they report on the ORYX performance measures, according to the Oakbrook Terrace, Ill-based The Joint Commission (TJC). While hospitals will still need to report on six sets of core measures, the accrediting agency explains that hospitals will no longer be mandated to report on acute myocardial infarction, heart failure, pneumonia, and surgical care improvement project (SCIP). The only measure set that will be mandatory for 2015 is perinatal care, and that is only for hospitals that have at least 1,100 live births per year. Other than the perinatal care requirement, hospitals will be able to select from the full complement of core measure sets.
In addition to these changes, accredited hospitals will be able to meet reporting requirements by submitting quarterly data in any one of three different ways, according to TJC:
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Reporting on six sets of 12 chart-abstracted measures;
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Reporting on six sets of seven electronic clinical quality measures;
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Reporting on six measure sets using a combination of chart-abstracted measures and electronic clinical quality measures.
In light of the altered reporting requirements, TJC is temporarily suspending the Performance Improvement (PI) standard PI.02.01.03, requiring hospitals to improve their performance on the ORYX measures, and Element of Performance (EP), requiring that accredited hospitals achieve a composite rate of at least 85% on the ORYX measures, because with the different ways that hospitals can meet the reporting requirements, the data will no longer have the same level of comparability to the previous year’s metrics. However, TJC notes that these requirements are likely to be reinstated in the future.
Jeannie Kelly, RN, MHA, LHRM, a quality assurance consultant at Soyring Consulting in Tampa, FL, suggests that these reporting changes are mostly good news for hospital administrators. “Hospitals have been channeling their resources into maximizing the outcomes for the mandated measures. However, in the past, these measures did not always reflect the strengths of [specific] hospitals,” she says. “Now, hospitals can focus on areas of success.”
Kelly adds that community hospitals, in particular, stand to benefit from the reporting changes. “Comparing teaching hospitals to community hospitals is like comparing apples to oranges. They both provide needed services, but you can’t expect a small community hospital to perform well on SCIP measures as compared to a large teaching hospital,” she observes. “Now the smaller hospitals can focus on other measures that more reflect their actual patient base. The global measurements of the past weren’t really distinct reflections of these smaller hospitals.”
In general, smaller hospitals have had a tougher time with the ORYX measures because they don’t have the resources of their larger cousins, offers Kelly. “The quality director [at a smaller hospital] may also function as the risk manager and the infection control guru,” she says. “Smaller hospitals struggle to produce data that accurately reflect their successes. They may not have the executive support or financial resources to change data collection practices at their facilities.”
Kelly’s advice to hospital leaders that have traditionally struggled with the ORYX measures is to focus on areas of success that reflect their patient base; this way, they will be able to showcase their facility’s strengths in care delivery.
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Jeannie Kelly, RN, MHA, LHRM, Quality Assurance Consultant, Soyring Consulting, Tampa, FL. E-mail: [email protected].
