Care Team Satisfaction Research Articles

ATA2023Annual Conference & ExpoMarch 4–6, 2023San Antonio, Texas

ATA2023Annual Conference & ExpoMarch 4–6, 2023San Antonio, Texas

P2.08-03 Patient Reported Lung Cancer Care Team Satisfaction and Treatment Dynamics, Based on the Online MyHealthTeams Survey

Understanding lung cancer (LC) patient satisfaction with their doctors and the drivers of this satisfaction are crucial to improving doctor-patient interactions, helping patients get on the right treatment path to help slow progression and improving health outcomes overall.

Oral Oncolytics: Using Remote Technology to Improve Access, Operational Efficiency, and Satisfaction.

Oncology care management via oral oncolytic therapy requires frequent laboratory monitoring for potential toxicities. A lag in these processes can result in treatment delays and care team dissatisfaction. A nurse-led quality improvement project was implemented to streamline processes, clearly define job tasks, and introduce a remote patient-reported symptom monitoring application to improve patient safety, access, operational productivity, and care team satisfaction. Project results included eliminating paper fax distribution, a 97% decrease in time required to process faxed remote laboratory results, and a 78% reduction in mouse clicks to complete laboratory orders and patient correspondence.

Improving the Culture of Safety: A Prospective Handoff Initiative from the Operating Room to the Trauma Intensive Care Unit

A recent EAST publication emphasized the importance of handoffs to ensure safe and effective care for trauma patients. In this work, we evaluated our existing handoffs from the operating room (OR) to the trauma intensive care unit (TICU) and implemented a formal process at our level 1 trauma center. Pre and post-intervention surveys were offered to the stakeholders. Responses were recorded in a Likert scaled format and results were compared using Student's t-test with statistical significance was set to .05. 57 surveys were completed (30 pre, 27 post) and 139 handoffs occurred. There was significant improvement in "overall satisfaction" and "understanding of information expected." Standardizing an OR to intensive care unit handoff clarifies expectations and improves care team satisfaction. While future studies are needed to evaluate the impact of structured handoffs on patient outcomes, provider satisfaction likely serves as an indicator for culture shift towards safer transitions of care for injured patients.

Multi-Disciplinary Discharge Coordination Team to Overcome Discharge Barriers and Address the Risk of Delayed Discharges.

BackgroundDelays in hospital discharge occur when patients are medically cleared but continue to remain hospitalized. Discharge delays can result in reduced levels of treatment, placing patients at risk of functional decline, falls and hospital-related adverse events. The Institute of Medicine has highlighted timely, efficient, and safe hospital discharge as a marker for quality care. Hospitals, however, are often unable to meet discharge targets. Research has shown improvements in discharge planning through system-level approaches that integrate health care and social work. The purpose of this study is to describe the development and implementation of a multidisciplinary team intervention to overcome discharge barriers for patients with prolonged hospitalization. We also evaluated the impact of the intervention on length of stay, readmission rates and care team satisfaction and morale.MethodsA multidisciplinary discharge coordination team met weekly to proactively raise and resolve patient-related discharge issues for all patients admitted to the general medicine wards. Members included hospitalists, case managers, social workers, hospital finance representatives, and patient representatives. One of the hospital physicians facilitated the meetings.ResultsBarriers to discharge included patient and family reluctance to discharge, medical delays in performing diagnostic tests or procedures, long-term care facility acceptance delays, and prolonged wait times for insurance approvals. Our multipronged approach decreased length of stay in our delayed discharge patient population from 15.45 days to 9.04 days, a 41.5% reduction, without an increase in readmissions. The healthcare team perceived the weekly multidisciplinary team meetings quite positively; 90% of respondents agreed that the meetings improved communication and increased their sense of support.ConclusionOur intervention was successful in improving hospital processes to overcome barriers to patient discharge. We believe that similar multidisciplinary meetings can be implemented in hospitals throughout the region to decrease risks of prolonged hospitalization and, ultimately, improve hospital efficiency and care delivery.

Clinician Burnout and the Meaningful Connection of the ACU Community.

Clinician Burnout and the Meaningful Connection of the ACU Community Douglas Olson, MD (bio), Craig Kennedy, MPH (bio), and Felix Nunez, MD, MPH (bio) Much has been said recently regarding clinician burnout in health care. Whether it be the disengagement of front-line care givers, mental health status of care teams, or potentially the worst—suicide, which is higher among health care professions that most all others—burnout is a serious part of health care delivery today. While the topic of burnout is a nuanced and complex one, there are three key tenets that require all those caring for the underserved to focus on at present. The Association of Clinicians for the Underserved continues to address all of these! 1. The concept of the triple aim in health care has shifted to the quadruple aim, which continues to encompass high quality care, low cost care and increased patient satisfaction, but now also the fourth element—increased care team satisfaction.1 2. The ECRI Institute, which works closely with the United States Health Research and Services Administration (HRSA), through which almost all community health centers receive malpractice insurance (Federal Tort Claims Act, or FTCA) has noted that burnout is one of 10 top patient safety concerns for 2019.2 3. While burnout can affect anyone, at any age, in any industry, it is important to note that there are certain sectors and roles that are at increased risk, and purpose-driven work—that is work (such as health care) which people love and about which they feel passionately—is one of them.3 Working in systems that support high-quality, patient-centered work—surrounded by a network of colleagues with shared ideals and goals—has defined the Association of Clinicians for the Underserved since its inception. From the many years of advocacy for the National Health Service Corps (NHSC), by many NHSC members and alumni, ACU has continued to be a leader in workforce retention and recruitment (most notably, through its recent work on the HRSA-funded STAR2 Center for Workforce). Burnout is not a new idea to ACU, nor is the concept of shared community, nor the data showing that being surrounded by a true community of peers helps to decrease (or, "treat") burnout. Now a bona fide syndrome with ICD-11 classification, the World Health Organization noted that the syndrome of burnout is characterized by three dimensions: 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one's [End Page 1] job, or feelings of negativity or cynicism related to one's job; and 3) reduced professional efficacy.3 According to Dike Drummond, MD—known to some as The HappyMD—"[R]esearchers are beginning to notice differences in the way physician burnout presents in men and women." For women it often begins with exhaustion and a feeling of not being able to recharge your batteries, followed by early signs of blaming your patients or clients. For men, it often begins with cynicism and blaming your patients or clients, followed by exhaustion and falling energy and engagement.4 Whether the sufferer is male or female, though, burnout has an impact on patient care: it not only produces less engaged employees, but also leads to reduced patient engagement, reduced patient satisfaction, reduced quality and value of care that is delivered, and increased risk for a health care error or mistake. Whether these impacts are recognized by a chief executive, medical or compliance officer, the chief financial officer will also be keen to note that burnout leads to increased staff turnover—costing organizations thousands or millions of dollars, well beyond the loss of organizational knowledge that results from employee change. Organizational risk management plans for 2020 are something ECRI strongly endorses, including efforts to measure (and perhaps mitigate) burnout. Patients are beginning to demand the same, and with good reason: they simply want more engaged care, delivered by more empathetic care teams, that is safer. Paul Huschilt, CSP (Canadian Speaker Hall of Fame) spoke with the ACU community at this year's 2019 annual ACU meeting in Washington D.C. As health care professionals, we face urgent demands, responsibilities and pressures. His talk, replete with laughter and concluded with...

Improving Efficiency and Meeting Expectations Without Compromising Care on Trauma Surgical Rounds

BackgroundCare teams on complex surgical services face a growing list of competing expectations. Approaches to quality improvement must use minimal resources and address both system and human requirements to meet expectations without compromising care. The purpose of this study was to demonstrate that iterative prototyping, combined with a rigorous quantitative evaluation approach, can effectively improve system and stakeholder efficiency on daily trauma surgical rounds at an academic safety-net hospital and level 1 trauma center. Materials and methodsThis study occurred between May 2017 and October 2017 at the Zuckerberg San Francisco General Hospital and Trauma Center. Care team members rounding on the trauma service included attending trauma surgeons, fellows, residents, interns, nurse practitioners, pharmacists, and medical students. We used human-centered design to develop and test solutions to improve the surgical rounding process. Each prototype was evaluated using qualitative design research methods, which informed the next iteration. Time observations of rounding activities were adopted from the Lean methodology and tracked before and after implementation. Intern work hours, on-time operative starts, and discharge order times were also tracked before and after implementation. ResultsFour prototypes were designed and iteratively implemented, producing care team satisfaction by the end of the implementation period. Discharge order times decreased by a median of 58 min, intern work hours were decreased by 97 min/d, and first operative case on-time starts increased from 40% to 63% (P < 0.05). The time spent on clarifications decreased by 4.7% (P < 0.05), allowing for more time to discuss care plans with the patients themselves. ConclusionsIterative prototyping as part of a human-centered design methodology is a powerful tool to address complex systems with diverse interests and competing priorities. Rapid, in-context prototyping is feasible on a complex trauma surgical service and can result in improved workflows and efficiency for the system and its stakeholders.

Evaluating the Impact of Secure Mobile Messaging on Communication and Cancer Care Team Satisfaction in a Large Radiation Oncology Clinic.

Communication is crucial in any clinical environment for efficient delivery of care and ensuring patient safety. A 2016 National Database of Nursing Quality Indicators questionnaire indicated poor physician-nurse satisfaction with communication in our department. We addressed gaps in our communication procedures by implementing a communication policy with a secure mobile messaging platform, and we surveyed care team members to evaluate the effectiveness of the implementation. We designed a policy around best communication practices and implemented a secure mobile messaging platform, Cureatr, which enables closed-loop, two-way communication that is compliant with the Health Insurance Portability and Accountability Act. Pre- and postimplementation surveys evaluated self-reported impression of efficiency, timeliness, effectiveness, and overall quality of communication, which were scored on a 5-point Likert scale. The number of messages sent was evaluated as a measure of uptake in use, and patient navigation data were queried to measure changes in clinic workflow. After implementation of Cureatr and a communication policy, survey responses demonstrated a clear improvement in staff satisfaction with the efficiency, timeliness, effectiveness, and overall quality of communication. The number of messages sent reflected a progressive increase in use of Cureatr; however, a consistent improvement in clinical workflow as measured by a decrease in patient in-room time was not appreciated. Implementing a secure messaging application with a communication policy improved cancer care team satisfaction with communication on all levels. Additional work is needed to evaluate the impact of secure messaging on clinical workflows, patient satisfaction, and staff well-being.

Assessing care team perspectives on integration of a community pharmacist into an ambulatory care practice

ObjectivesThe objective was to advance the integration of a community pharmacist within an accountable care organization (ACO) by assessing the desired roles of a pharmacist within the care team, satisfaction with the current arrangement of a pharmacist’s involvement, and willingness to learn more about the roles of a community pharmacist. SettingA community pharmacist from Realo Discount Drugs was embedded within 3 clinics associated with Coastal Carolina Quality Care, an ACO. Practice descriptionAn independent community pharmacy established a partnership with an ACO that has multiple group practices and shares an electronic health record. Practice innovationCare managers referred patients to the pharmacist. The goal of community pharmacist involvement within the clinic was to provide transitions-of-care services to recently hospitalized patients, reconciling medications and dosing after discharge. EvaluationA 12-item online survey was conducted to evaluate the partnership. Health care team members were included; staff without expected involvement with the patient or pharmacist were excluded. Questionnaire items addressed provider type, desired role of the pharmacist, satisfaction with pharmacist involvement, and willingness to learn about or desire for more pharmacist involvement. The survey was open for 30 days with a reminder sent on day 15. Responses were thematically categorized, and content analysis was used to analyze results. ResultsSixteen survey responses were received. The care team most frequently requested that the community pharmacist provide medication reconciliation (50%), medication education (44%), cost-reduction strategies (44%), and drug-interaction evaluation (38%). Care team satisfaction was positive; no respondents were unsatisfied. One-third (37%) of respondents were unaware of the pharmacist’s involvement, had not referred patients to the pharmacist, or desired more interaction with the pharmacist. ConclusionSurvey findings were used to advance community pharmacist integration within an ACO, resulting in meaningful changes to pharmacist-provided services within clinic workflow.

A Multidisciplinary Handoff Process to Standardize the Transfer of Care Between the Intensive Care Unit and the Operating Room.

Critically ill patients are at high risk for adverse events on transfer between intensive care unit and operating room. Patient safety concerns were raised within our institution during such transfers, and absence of a standardized patient handoff process was identified as an area of concern. The current state of the patient transfer processes between the intensive care units (ICUs) and the operating rooms (ORs) was mapped and failure modes were identified. A multidisciplinary team was convened and a standardized handoff process and tool (checklist) was developed. Adherence to the process and care team satisfaction was assessed at the end of a 60-day pilot period. The process was successfully implemented hospital-wide covering all adult and pediatric ICUs. We observed a 90% compliance rate with ICU to the OR transfers and 95% compliance rate with transfers from OR to the ICU during the 60-day pilot period. The care team expressed overall satisfaction with the process and identified potential areas of improvement. A standardized patient handoff process between the ICU and the ORs can be successfully implemented in a large academic medical center. Universal application of this quality improvement tool can reduce patient harm, improve communication between providers, and enhance patient safety.

Interprofessional Collaboration With Pharmacist-Driven Education for Hypertension Control in Federally Qualified Health Center Patients

Providing collaborative care is essential to decrease cardiovascular complications of hypertension (HTN). Care coordination models, including the Patient Centered Medical Home (PCMH), are advocated to manage chronic diseases. However, they offer no guidance on collaborative strategies to improve patient outcomes. This project enhanced the PCMH model at a Federally Qualified Health Center (FQHC) through application of interprofessional collaboration (IPC) concepts including role optimization, shared decision making, shared power, and care expertise. Application of IPC concepts with the key addition of a pharmacist education component was instituted at a Midwestern FQHC over a 60-day period with a single care team. Inclusion criteria included adult patients with a diagnosis of uncontrolled primary HTN (>140/90). Blood pressure, perception of IPC, and patient and care team satisfaction were measured. Descriptive statistics, paired t-test, and unpaired t-test were used for analysis. Twenty-two patients participated in the process change. Mean BP demonstrated a statistically significant decline. Care team perception of IPC improved. Care team members and patients reported satisfaction with the overall process change. This project offers support to increase knowledge of how IPC competencies and concepts can be incorporated into an FQHC and the effect it may have on hypertensive patients being treated under a PCMH model.

The Integrated Pain Team: A Mixed-Methods Evaluation of the Impact of an Embedded Interdisciplinary Pain Care Intervention on Primary Care Team Satisfaction, Confidence, and Perceptions of Care Effectiveness.

To evaluate the impact of the Integrated Pain Team (IPT)-an interdisciplinary chronic pain care intervention embedded in primary care at a large Veterans Affairs health care system. Outcomes evaluated included IPT's impact on the perceived effectiveness of chronic pain care; provider self-confidence; and primary care team satisfaction, stress, and burnout. This mixed-methods quality-improvement study employed: 1) qualitative semistructured interviews of 61 primary care providers, other primary care team members, and organizational stakeholders; and 2) a supplementary quantitative survey of 65 providers, comparing those who had referred patients to IPT with those who had not. Most interview participants reported that IPT improved chronic pain care by providing patients with a comprehensive pain treatment plan, educating them about opioid risks, and introducing multimodal treatment options. Interviewed care team members reported improved patient education and fewer emotionally charged contacts from patients. Interviewed providers felt that IPT allowed them to focus their time on health concerns other than pain. However, our supplemental survey found that IPT-utilizing providers were no more confident than other providers in their own pain care skills or in their relationships with chronic pain patients. Integrating an interdisciplinary chronic pain care intervention into primary care can provide needed support to care teams and may improve chronic pain care. Elements of the IPT model identified as important to its effectiveness include its interdisciplinary biopsychosocial approach and attentive patient follow-up. However, enhancing providers' confidence and self-efficacy in chronic pain care may require educational and support resources beyond the current IPT model.

The use of patient factors to improve the prediction of operative duration using laparoscopic cholecystectomy.

Reliable prediction of operative duration is essential for improving patient and care team satisfaction, optimizing resource utilization and reducing cost. Current operative scheduling systems are unreliable and contribute to costly over- and underestimation of operative time. We hypothesized that the inclusion of patient-specific factors would improve the accuracy in predicting operative duration. We reviewed all elective laparoscopic cholecystectomies performed at a single institution between 01/2007 and 06/2013. Concurrent procedures were excluded. Univariate analysis evaluated the effect of age, gender, BMI, ASA, laboratory values, smoking, and comorbidities on operative duration. Multivariable linear regression models were constructed using the significant factors (p<0.05). The patient factors model was compared to the traditional surgical scheduling system estimates, which uses historical surgeon-specific and procedure-specific operative duration. External validation was done using the ACS-NSQIP database (n=11,842). A total of 1801 laparoscopic cholecystectomy patients met inclusion criteria. Female sex was associated with reduced operative duration (-7.5min, p<0.001 vs. male sex) while increasing BMI (+5.1min BMI 25-29.9, +6.9min BMI 30-34.9, +10.4min BMI 35-39.9, +17.0min BMI 40+, all p<0.05 vs. normal BMI), increasing ASA (+7.4min ASA III, +38.3min ASA IV, all p<0.01 vs. ASA I), and elevated liver function tests (+7.9min, p<0.01 vs. normal) were predictive of increased operative duration on univariate analysis. A model was then constructed using these predictive factors. The traditional surgical scheduling system was poorly predictive of actual operative duration (R 2=0.001) compared to the patient factors model (R 2=0.08). The model remained predictive on external validation (R 2=0.14).The addition of surgeon as a variable in the institutional model further improved predictive ability of the model (R 2=0.18). The use of routinely available pre-operative patient factors improves the prediction of operative duration during cholecystectomy.

Transformation of Care: Integrating the Registered Nurse Care Coordinator into the Patient-Centered Medical Home.

The purpose of this quality improvement project was to implement and evaluate a care delivery model integrating the registered nurse care coordinator (RNCC) into a family practice that is certified as a patient-centered medical home (PCMH) by the National Committee for Quality Assurance. The initial target population was the 937 patients with diabetes in the family practice. A pre-post design was used to assess changes in patients' diabetic quality indicators after integrating the role of RNCC using existing staff. This 6-month project compared the following diabetic quality indicators: blood pressure < 140/90 mm Hg, hemoglobin A1c ≤ 7, low-density lipoprotein cholesterol < 100 mg/dL, documentation of smoking cessation counseling, and aspirin prescription if existing vascular disease. Yearly documentation of microalbuminurea level, and filament foot and retinal examination was assessed. Patient and health care team satisfaction also was measured. Care coordination interventions included: telehealth, group visits, standardized individual patient education, as well as creative uses of the electronic medical record for workflow changes, daily huddles, and monthly meetings. The results were positive, statistically significant differences in the pre and post scores for A1c (P = .001, n = 790), foot exam (P = .001, n = 850), and microalbumin (P = .01, n = 850). Post intervention, patient and health care team satisfaction with the RNCC role was high (mean scores ≥3 on a 5-point Likert scale). Integrating the RNCC within a multidisciplinary team in the PCMH had a significant positive impact on diabetic quality indicators. Patient and health care team satisfaction with the RNCC role was high.

Implementation of a Model of Robotic-Telepresence (RTP) in the Neuro ICU and Effect on Critical Care Team Satisfaction (P02.213)

Objective: We hypothesized that RTP (Remote Tele-Presence) for after-hour ICU rounds would be associated with improved critical care team satisfaction. Background RTP is a form of mobile telemedicine, which enables a direct face-to-face rapid response by the physician, instead of the traditional telephonic paradigm. Design/Methods: We implemented a prospective nighttime multidisciplinary ICU round time, using RTP at our NICU from 01/24-02/02/11. During our trial, we used RTP for conventional NICU activations and performed obligated nighttime rounds from 8pm-12am discussing the patient with bedside NICU-nurse. To test for critical care team satisfaction, a pre-post questionnaire was implemented containing three main questions for day and night time nurses: Q1) is the intensivist sufficiently available to the ICU; Q2) during patient care emergencies, is there adequate physician involvement and support; and Q3) I have enough opportunity to ask questions of the ICU physician team. Answers were trichotomized into: Disagreement (D), Agreement (A), and No Opinion (NO). We then calculated proportion differences (PD). Results: During this pilot study, overall improvement in the perception of ICU attending level back-up, particularly during nights, was observed from the nursing staff: Q1-day, D 26 % vs. 13%, PD 14%, A 38% vs 55%, PD -14%; Q2-day, D 21 % vs. 5%, PD 16%, A 44% vs. 65%, PD -21%; and Q3-day, D 24 % vs. 15%, PD 9%, A 41% vs. 52%, PD 11% and Q1-night, D 73 % vs. 50%, proportion difference [PD] 23%, A 6% vs 20%, PD -14%; Q2-night, D 62 % vs. 35%, PD 27%, A 24% vs. 35%, PD -11%; and Q3-night, D 62 % vs. 45%, PD 17%, A 21% vs. 25%, PD -4%. Conclusions: This data suggests improvement in critical care team satisfaction with RTP in NICU, particularly during nighttime hours. RTP is a tool that may be used to improve patient care. Disclosure: Dr. Rincon has nothing to disclose. Dr. Vibbert has nothing to disclose. Dr. Caliguri has nothing to disclose. Dr. Childs has nothing to disclose. Dr. Fry has nothing to disclose. Dr. Urtecho has nothing to disclose. Dr. Jallo has nothing to disclose.