Successful applicants to the ASGE Endoscopy Unit Recognition Program submit a summary of a recently conducted quality improvement (QI) project as part of the application process. The quality assurance and performance improvement (QAPI) project in the spotlight this issue looked at improving patient post-procedure discharge instructions.
DEFINE
The GI endoscopy service determined by using patient experience and complaint data that patients were frequently not receiving adequate discharge instructions. This resulted in a low patient satisfaction score, increased volume of after-hours calls to the provider offices, and patient complaints about the service they received. Spanish speaking patients and older patients reported they did not understand what to do after discharge more often than English speakers and younger patients, reflecting health disparities in our patient population.
MEASURE
The hospital solicits patient satisfaction surveys from 100% of patients using a validated survey tool provided by a national survey vendor to manage the survey collection and processing. Results from patient surveys provide a valid and comprehensive data set reflecting the patient experience of care and perceptions about gaps in services and care. The Quality Department maintains a grievance log of patient complaints about care and service. This log may be analyzed for volume and nature of patient complaints among GI patients.
ANALYZE
National Research Corporation (NRC) data was analyzed for overall patient satisfaction among GI patients, then the data was sliced and diced to analyze at question level, then by race, ethnicity, language, gender and age. Gaps were identified among all GI service patients, with the baseline report showing that patients reported a 9 or 10 /10 score for the question about discharge information 82.6% of the time. Spanish speaking and sixty-five and older patients reported the lowest understanding of discharge and follow up instructions.
IMPROVE
A stoplight tool was developed for post-endoscopic procedures. A stoplight tool is an Agency for Healthcare Quality and Research (AHRQ) model tool for patients to be able to understand what to do after discharge, what to eat, signs and symptoms of complications and when to call their provider with concerns. The stoplight tool is in sixth grade language, and provides green, yellow and red zones to indicate when a symptom is normal or of immediate concern. A non-clinical Patient/Family Advisor and a GI provider assisted staff to develop the tool. The tool was translated into Spanish and is now provided to all GI patients by the admitting RN as part of the pre-procedure education.
Between the second and fourth quarter of 2023 the overall patient satisfaction score rose from 93.2% to 97.4%, and the score for the question about discharge information improved from 82.6% to 85.9% of patients reporting 9 or 10 /10 on the patient experience surveys.
CONTROL
At the beginning of 2024 the hospital converted to the Press Ganey system and is using the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers & Systems (OAS CAHPS) survey in 2024. The goal is to meet the p75 level for GI patient satisfaction. Question level data with race, age, language preference and gender breakdowns are not available yet. Overall, patient experience data is monitored monthly by the Quality Department. Data is reported to the Unit Manager and frontline staff. The Quality Department reports they have not received any complaints about discharge information from patients since the stoplight tool was implemented. The GI department has maintained their overall goal of p75 overall patient satisfaction throughout 2024. As more data regarding underserved populations becomes available in the Press Ganey system, the unit will revisit the discharge information provided to patients.
We hope sharing this project summary will be useful to you and your practice.