Friday Feature: Back to the Future and Care Rounds

TGIF! A frequent reader sent me a note earlier in the week and asked if I would drop in more clinically oriented stuff from time to time. I asked for details, and she said stuff “that is germane to patient care and operational improvements – QA/QI stuff”. So, today’s post is by request, sort of.

I ran across a little case study piece from Sound Physicians about their work in a North Texas teaching hospital to improve patient satisfaction or HCAHPS. HCAHPS are patient surveys about their care that translate into scores. The acronym stands for Hospital Consumer Assessment of Healthcare Providers and Systems. The post-acute cousin is found in Home Health and Hospice as they use a similar survey methodology known CAHPS (Home Health Consumer Assessment, Hospice Consumer Assessment…). The data gathered is publicly posted for each provider (Medicare participating).

CAHPS surveys follow specific principles in their design.  The surveys are designed to assess the experiences of large patient samples. Experience surveys focus on what and how patients experienced or perceived key aspects of care, not whether they were satisfied with their care. “Patient experience surveys focus on asking patients whether or how often they experienced critical aspects of health care, including communication with their doctors, understanding their medication instructions, and the coordination of their healthcare needs“, per the CMS CAHPS website ( ). Some surveys (home health, hospital, hospice) can impact reimbursement, typically as a VBP (Value Based Purchasing) measure.

In this case study and at this hospital in Texas, Sound was the hospitalist group ( Sound and the hospital were apparently interested in improving their HCAHPS scores.  For whatever reason, patient participation and provider engagement with the survey process was low. 

To improve the HCAHPS scores via increased participation and patient engagement, Sound implemented Multi-Disciplinary Rounding (MDR). This acronym, MDR, is the cause of the Back to the Future title of this post. From their presser, “Sound’s medical director and clinical performance nurse (CPN) implemented leadership discharge rounding with patients. They visited patients nearing discharge to ask them a series of questions about their care and experience during their stay. Two months after implementing leadership rounding, the team also implemented a more formalized approach to multidisciplinary rounds (MDRs), coordinating care and discharge for patients who were ready to go home”.  Sound’s press release/case study piece is available here: 202306_HM_MDR_HCAHPS_Case_Study

Per Sound, within a month of the rounding program, HCAHPS scores improved. By using the rounding approach, the team was able to connect with 85 to 90 percent of their patients which, prior to the rounding process, only 25 percent of patients were seen.  Not too surprising, over a six-month period, HCAHPS score showed an 8.4% improvement and lengths of stay for patients decreased by almost a day (.8). According to Sound and their experience, “seeing these patients on or near their date of discharge as part of their rounding process, the team was able to uncover barriers to a timely discharge, such as whether the patient had called their family to let them know they’d been cleared to leave, needed transportation,
or had received their medication and dosage instructions“.

Heading ‘back in time’, last year I wrote a post about care coordination. It is available here:   Within that post is a presentation I was part of in 2017 on care coordination.  The presentation is also available on the Presentations page, titled care-coordination-updated. The program was presented at LeadingAge’s Annual Meeting and Convention in New Orleans that year.

My point is this. Care rounds are not new and, in some cases, were being effectively used to improve outcomes, reduce lengths of stay, reduce rehospitalizations, and improve patient experience many, many years ago (almost a decade ago).  It’s great that Sound used this approach to improve experience and ultimately, improve outcomes (it seems) as well.  More providers should try it.

Care coordination, as I have done it and watched it integrated at a high level, can produce significant improvements in patient experience and care outcomes, particularly at the discharge point. When cost matters, reducing redundancies and improving rehospitalization rates can produce important savings. Reputationally, patients that have a good experience and great outcomes, become ambassadors and more important, are less likely to be litigants (or their families and significant others).  Feel free to grab the presentation and adapt the tools that are in it!  TGIF and enjoy the weekend!  I know I certainly will.



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