Increased Patient Satisfaction Scores Research Articles

Hubungan Kualitas Pelayanan Bagian Pendaftaran Rawat Jalan terhadap Kepuasan Pasien RS X Purwodadi

Service quality has a direct impact on patient satisfaction assessments. In Purwodadi Regency there are only twelve hospitals. One of these hospitals is Hospital X, which is the most preferred reference by the public. The aim of this research is to determine the relationship between service quality in the registration department and outpatient satisfaction at X Purwodadi Hospital. The approach taken in this research is quantitative-analytic with a cross sectional study. This research was carried out from April to July 2023. Samples were taken using accidental sampling with a population of 107,520 patients and samples taken of 100 respondents using the Slovin formula calculation. The research instrument used a structured questionnaire. The results of the research show that there is a relationship between the quality of registration department services and outpatient satisfaction at Hospital X Purwodadi which includes components: tangibles with a p-value of 0.000 < 0.05; reliability with p-value 0.006 < 0.05; responsiveness with p-value 0.000 < 0.05; assurance with a p-value of 0.000 < 0.05; and empathy with a p-value of 0.000 < 0.05. Overall, the total percentage of patient satisfaction is 70%. Thus, it can be concluded that to increase patient satisfaction scores, hospitals are obliged to improve the quality of service in every department.

Use of Remote Physiologic and Therapeutic Monitoring Following Total Knee Arthroplasty.

Remote physiologic monitoring (RPM), or remote therapeutic monitoring (RTM), has grown exponentially for the management of chronic medical diseases in Medicare patients. More recently, the application of this technology has ventured into the orthopaedic arena, and more specifically, for total joint arthroplasty. Platforms to expedite this monitoring can provide continuous biodata feedback on digital biomarkers to patients and surgeons, which can potentially help improve and create novel patient-specific recovery pathways. Furthermore, various devices developed for this monitoring might help obviate the need for frequent emergency room visits, readmissions, and prolonged outpatient physical therapy sessions, as well as reduce complications and increase patient satisfaction scores after total joint arthroplasty surgery. However, while there are a number of potential benefits to technology for this type of care, its application following total knee arthroplasty has not been well-studied. Therefore, after an overview of the usage of RPM and RTM, the purpose of this study was to review the current literature regarding three common remote monitoring technologies: 1) smartphone apps; 2) wearables; and 3) combined smartphone apps and wearables. We also considered the potential financial implications of remote physiologic monitoring. A comprehensive search of the PubMed, Cochrane Library, MedLine, and Web of Science databases was performed. Three main subgroups of monitoring devices were included for analysis: smartphone apps, wearable devices, and combined wearable plus smartphone app platforms. Searches focused on remote physiologic monitoring, patient-specific advantages, financial advantages, billing and coding options, as well as overall efficacy of platforms. The current review found smartphone apps, wearables, and combined smartphone app and wearable platform technologies to be advantageous in the postoperative period following total knee arthroplasty. The wearable components can provide highly accurate and reproducible data, which the user-friendly smartphone app can relay to the patient so they can easily understand their progress. Additionally, through the apps, patients can directly access their surgical team. By constantly collecting and evaluating range of motion and functional data, the surgical team can identify if the patient is appropriately progressing through treatment or if further intervention is warranted. The incorporation of the remote physiologic monitoring devices during the post-total knee arthroplasty period shows strong promise as a progress-tracking modality. Published benefits include reduced physical therapy visits, decreased pain scores and reliance on opioids, increased activity levels as assessed by step counts, increased ability to follow less well-performing patients, reduced readmissions, reduced in-person clinic visits, and decreased postoperative costs.

A New Dressing System for Wound in Enhanced-Recovery Total Hip Arthroplasty: A Randomized and Controlled Trial

BackgroundCurrently, there is a paucity of recommendations in regards to dressing selection within the enhanced recovery after surgery protocol. We devised a new dressing system to accelerate the recovery after total hip arthroplasty (THA). We aimed to present our experience with this new dressing system as an adjunct to wound management in THA and to evaluate its performance. MethodsFrom September 2020 to August 2021, we prospectively enrolled 124 patients who underwent a primary THA. The patients were randomly assigned to the intervention (the new dressing system group) or the control (the traditional gauze dressing) group. The primary outcome measures of this study were numbers of dressing changes, postoperative lengths of stay, wound scores including the Stony Brook Scar Evaluation Scale and ASEPSIS scores and wound-related complications. The secondary outcomes include satisfaction scores, dressing-related costs, and pain and functional recovery scores. ResultsThe intervention group numbers of dressing changes and postoperative lengths of stay were significantly less than the control group (P < .001, P < .001). During the one-month follow-up, the Stony Brook Scar Evaluation Scale in the intervention group was significantly better than that in the control group (P < .001). The intervention group satisfaction was significantly higher than that in the control group (P < .001). There were no statistically significant differences between the two groups in terms of dressing-related costs and pain and function scores. ConclusionThe new dressing system could significantly reduce the number of dressing changes and postoperative lengths of stay and increase patient satisfaction scores, which can be an ideal adjunct to wound management in enhanced-recovery THA.

Collaboration With Advanced Practice Registered Nurses to Improve Patient Satisfaction in Outpatient Clinic

Patient satisfaction has become an indicator for measuring quality and is linked to clinical outcomes, patient retention, and patient-centered care. A vascular surgery division in a tertiary care referral center found that the increase in the volume of patients necessitated the addition of advanced practice registered nurses (APRNs) to assist in the care of these patients. The Press Ganey Medical Practice Survey was used to track patient satisfaction scores before and after integration of an APRN into the outpatient clinic and showed that having the APRN increased patient satisfaction scores.

Improving the Patient Experience Through a Preoperative Educational Initiative

<h3>Introduction</h3> Preoperative teaching has the ability to increase patient satisfaction, patient knowledge, and minimize anxiety related to the surgical procedure. Preoperative nurses are in a unique position to provide patients with the educational tools needed to better prepare them for surgery. This project addresses the need for improved patient preoperative teaching to ensure a positive patient experience and improved outcomes for our patients, and their families. <h3>Identification of the Problem</h3> During preoperative admission, we encounter patients that, are ill prepared regarding their surgical procedure. This lack of knowledge leads to increased uncertainty and anxiety. Furthermore, our Press Ganey (PG) scores related to the ‘Information nurses gave you as they helped to prepare you for the procedure', and ‘Nurses response to your concerns or questions' indicate that there is room for improvement. <h3>Purpose of the Study</h3> To evaluate the effectiveness of a preoperative educational initiative to better prepare patients for surgery. <h3>Methods</h3> Provided staff in-service emphasizing preoperative nursing interventions, including clear preoperative call instructions, patients' learning needs assessment, and the use of electronic and printed educational resources. Developed a list of suggested questions with commonly asked questions for patients to ask the perioperative team. After implementation, patients completed surveys over a three-month period of time to ascertain patient preparedness for surgery, which yielded 100 responses. <h3>Outcome/Results</h3> Patient preparedness is measured by the patient survey and PG scores on the indicator questions. Survey results show that 100% of patients received all the information needed to prepare them for surgery from the nursing team during the preoperative call and on the day of the surgery. Post-intervention PG scores on both indicator questions were 92.9 and 94.1, respectively, versus 91.7 and 92.7 pre-intervention PG scores. <h3>Discussion</h3> The preoperative educational initiative in this study proves successful to better prepare patients for surgery, as evidenced by survey results and increased patient satisfaction scores. <h3>Conclusion</h3> Quality patient teaching tailored to the patient needs has the ability to positively impact the patient experience, resulting in greater patient satisfaction and successful patient outcomes. <h3>Implications For Perianesthesia Nurses and Future Research</h3> Perianesthesia nurses are well positioned to ensure that patient education expectations regarding any surgical procedures are fulfilled, leading to optimal patient outcomes, and ultimately patient experience.

Nurse Initiative Driven Project Results in Increased Patient Satisfaction Scores

<h3>Introduction</h3> Since acquiring Interventional Pulmonary procedures within the last year, patient satisfaction scores showed consistent opportunities for improvement in discharge preparedness. <h3>Identification of the problem</h3> During Shared Governance discussions, it was determined that electronic medical record discharge instructions did not include procedure specific information. This lead to frustration amongst the staff due to being unable to answer the patient's questions. <h3>QI question/Purpose of the study</h3> The purpose of the study was to increase patient preparedness for discharge, including questions specific to what to do for bleeding, infection, pain, and patient perception of being prepared for recovery/discharge. <h3>Methods</h3> The Post Anesthesia Care Unit nurses collaborated with Endoscopy procedure nurse to develop specific procedure discharge instructions. The discharge instructions were then given to the head of the Interventional Pulmonology department for approval. Once approved, the discharge instructions were uploaded into the EPIC EMR system. A tip sheet was developed on how to attach the new discharge instructions to the patient After Visit Summary as a reference. Additionally, the Endoscopy procedure nurse developed and provided education to the PACU staff to increase understanding of the Interventional Pulmonary procedures. <h3>Outcomes/Results</h3> Patient satisfaction scores in the below categories increased within the three month implementation period: - Prepare for Recovery: 75 percent to 100 percent - Bleeding: 75 percent to 84.2 percent - Pain 58: percent to 100 percent - Infection: 58.3 percent to 88.9 percent Additionally, our post- procedure phone calls and surveys reported less concerns. <h3>Implications for perianesthesia nurses and future research</h3> Our Shared Governance reviews patient satisfaction scores and reports on a regular basis, thus leading to this idea for interdisciplinary collaboration. We are looking to further review other specialties that would benefit from enhanced discharge education for patients.

Pioneering a Value-Based Purchasing Initiative for Ambulatory Surgery Centers in TRICARE West.

Pioneering a Value-Based Purchasing Initiative for Ambulatory Surgery Centers in TRICARE West.

Is it Noise? Factors Linked With Sleep Interruption in Hospitalized Patients.

The aim of this study was to explore the perceived quality of sleep and sleep disturbances in hospitalized patients. A prospective descriptive, exploratory, cross-sectional study was conducted at a 172-bed community hospital in Northeast Ohio. A convenient sample of 100 hospitalized patients was recruited from medical/surgical, progressive care, and intensive care units. Participants used the Richards-Campbell Sleep Questionnaire to report sleep. A quality of sleep assessment survey was used to collect information regarding 17 factors leading to decreased quality of sleep. Mean sleep score was 47.92 for each question regarding sleep depth, latency, awakenings, time spent awake, and overall sleep quality. Pearson's correlation showed a significantly positive correlation between measure of noise and sleep score. Five environmental factors were identified as most disruptive to sleep: pain, laboratory draws, staff, blood pressure checks, and intravenous alarms. The positive correlation between sleeping well and higher noise levels is noteworthy. Raising awareness about the importance of sleep in the hospital setting and introducing interventions to promote a quiet environment and minimize sleep-disturbing factors may increase patient satisfaction scores and improve healing.

Enhancing Residents' Warmth in Greeting Caregivers: An Inpatient Intervention to Improve Family-Centered Communication.

Hospitals are increasingly motivated to improve the patient and family experience and increase patient satisfaction scores. The manner by which a provider greets patients and their families sets the tone for the hospital stay. This study aimed to improve residents' greetings of caregivers in the inpatient pediatric setting to improve family-centered communication. The study was conducted from October 2017 to April 2018 at a single, urban children's hospital on a unit with patients primarily <5 years old. The intervention consisted of posting a prominent board outside of patients' rooms that (1) listed caregivers' preferred names (e.g., Mom/Dad, first names), (2) instructed residents to greet caregivers warmly by their preferred names, and (3) identified residents for families by name and photograph. During implementation, we conducted 5 Plan-Do-Study-Act cycles and surveyed 114 caregivers. Improvement was assessed using run charts. The primary outcome was the percentage of caregivers who rated residents' warmth of greetings as "excellent." This measure increased from a baseline median of 62.5%-84.4% with ≥6 consecutive postintervention points above the baseline median. The intervention improved caregiver-perceived quality of residents' greetings and could serve as a model for other hospitals to enhance provider-family rapport and improve communication.

Purposeful Hourly Rounding to Decrease Peripheral Intravenous Infiltrations and Extravasations in Pediatrics

PurposePediatric patients are at high risk for peripheral intravenous infiltrations and extravasations (PIVIE) resulting in patient harm. Structured hourly rounding has demonstrated to improve quality outcomes. The purpose of this quality improvement project was to implement structured hourly rounding to decrease the median rate of moderate PIVIE rates from 3.13 to 2.58 per thousand patient days over a 6-month time period in pediatric patients with infusing continuous IV fluids. Design and methodsA pilot was conducted to hardwire hourly assessments for peripheral intravenous lines (PIV) in pediatric patients with continuous fluids utilizing a structured hourly rounding process. Bedside nurses utilized the P.A.T.H. model to assess pain management (P), assess PIVs for early PIVIE recognition (A), address things patient and family may need (T), and reduce the occurrence in hospital acquired conditions (H). Data was collected on unit nurse sensitive indicators and compliance to hourly rounding. ResultsStructured hourly rounding using the P.A.T.H. model successfully hardwired hourly PIV assessments. The unit reduced their median moderate PIVIE rate to 1.83 per thousand patient days, an 41% improvement. The pilot also had positive unintended consequences of improved pain reassessment from 67% to 100%, increased patient satisfaction scores of 67% to 97% and reduced patient falls by 29%. ConclusionsStructured hourly rounding using the P.A.T.H. model can positively hardwire hourly PIV assessments in pediatric patients. Practice implicationsSustainability of hourly rounding requires leadership support and nursing commitment to impact quality metrics. Organizations should consider implementing focused hourly rounding to address PIVIEs.

Health related quality of life varies by weight loss method in patients with history of nonalcoholic fatty liver disease

AbstractWeight loss through lifestyle modification is currently the standard of care in the management of patients with nonalcoholic fatty liver disease (NAFLD); however, benefits of specific strategies for achieving weight loss in these patients are poorly understood. We sought to determine whether patient satisfaction and health‐related quality of life (HRQoL) vary by specific weight loss method in patients with NAFLD. Patients diagnosed with NAFLD in the previous 6 months to 3 years were identified through chart review at our urban, tertiary medical center. Participants were administered an online questionnaire assessing liver disease and weight loss history, HRQoL, and satisfaction with their weight loss method. Patients who incorporated caloric restriction into their weight loss plans had lower total HRQoL scores (5.0 vs 5.4, P = .05) as compared to patients who did not include this method. Multivariate analysis showed that caloric restriction was independently associated with lower HRQoL scores (β = −2.25, P = .03). Weight loss was associated with both increased total HRQoL scores (5.3 vs 4.9, P = .05) and increased patient satisfaction scores (3.3 vs 2.1, P = 4.00 × 10−10). Our data demonstrate that incorporation of caloric restriction into a weight loss plan is associated with lower HRQoL. Choosing a weight loss strategy associated with improved quality of life could be an important factor in improving adherence and patient outcomes.

The Process of Implementing a Mobility Technician in the General Medicine and Surgical Population to Increase Patient Mobility and Improve Hospital Quality Measures: A Pilot Study

Background: Hospital-associated disability (HAD) has been linked to prolonged and inappropriate immobility. HAD and increased postacute care (PAC) rehabilitation spending are also associated. Purpose: This pilot aims to describe the implementation processes of a designated mobility technician (MT), providing daily mobility on a medical and surgical acute care unit. During the MT implementation, we explore the resulting effects on patient length of stay (LOS), PAC utilization, patient satisfaction, falls, and hospital cost. Methods: A quality improvement pilot study was created comparing the percentage of PAC discharge locations before and during the mobility pilot (MP) on 1 general medical (GM) unit (37 beds) and 1 general surgical (GS) unit (27 beds). Following the nursing assessment of medical stability and mobility with a progressive mobility algorithm, patients were assigned a Johns Hopkins Highest Level of Mobility (JH-HLM) score and placed on the MT schedule. The MT mobilized each selected patient to the next appropriate level of mobility, with a goal of at least 1 JH-HLM level of increase and recorded the score. Patient discharge location was recorded at the end of the inpatient stay. Patient satisfaction scores, LOS, and incidence of falls were also monitored throughout the pilot. Outcomes: Eighty-nine percent of GM compared with 83% of the baseline data group patients and 83% of the GS compared with 90% for the baseline data group patients discharged to home with an average increase in JH-HLM score of 1.22 per mobility session. In addition, during the MP both units decreased the LOS by 5.84% to 9.03%, the GS unit experienced increased patient satisfaction scores by 9.19%, and both units improved Press Ganey ratings of Responsiveness of Staff by 16.47% to 37.00%. No falls were associated with the MT or MP and the GM unit decreased overall falls by 53.3%. Discussion: The MP is a promising tool for increasing patient mobility in the nonintensive care GM and GS setting, while potentially decreasing the need for PAC rehabilitation for many patients with minimal mobility deficits. Although not all of the results were statistically significant, positive effects on hospital ratings show promise toward helping to improve the overall patient experience during admission, decreasing LOS, decreasing overall fall rate, and an associated decrease in GM patient PAC spending in those most likely to be affected by HAD related to immobility. These positive effects can potentially improve hospital profit margins through the Centers for Medicare &amp; Medicaid Services' value-based purchasing reimbursement program.

The influence of enhanced recovery after cardiac surgery on 30-day readmission rate, hospital and ICU length of stay

Introduction Enhanced Recovery After Surgery (ERAS) pathways have been proven to increase patient satisfaction scores, decrease the complication rate, decrease the length of stay (LOS), and decrease cost for many surgical specialties. Recently, ERAS for cardiac surgery guidelines have been published and are being implemented in many centers. However, few data are reported on clinically important outcomes. We examined the effect of ERAS for cardiac patients on the duration of mechanical ventilation, ICU and hospital LOS.¹ Methods We retrospectively analyzed prospectively collected outcome data of patients undergoing cardiac surgery enrolled in the ERAS pathway (n = 115) compared to a historical standard care group (n = 188). The ERAS pathway included pre-operative patient education, multimodal pain management to minimize opioid usage, carbohydrate loading 2-4hrs before induction of anesthesia, minimizing crystalloid infusions, tight glucose control, early postoperative invasive access and chest tube removal, early extubation, and early mobilization. The standard care group was treated per preexisting institutional guidelines. Data were compared using univariate analysis: parametric and non-parametric data were analyzed with Student's t-test and Wilcoxon rank-sum test, respectively. A p-value of less than 0.05 was considered statistically significant. Results The median (25th, 75th) intensive care unit (ICU) length of stay (LOS) was 1 day (1, 2) in the ERAS group and 2 days (1, 3) in the standard care group (p Discussion The Enhanced Recovery Pathway after Surgery pathway uses a standardized approach to perioperative patient care. Implementation of ERAS for cardiac surgery results in shorter ICU and hospital LOS, comparable ICU and 30-day readmission rates, without a noticeable increase in 30-day mortality. Further studies focusing on other relevant outcome parameters are warranted.

Abstract WP499: Effective Communication Between Nurses and Physicians Leads to Better Patient Outcomes!

Background: Open lines of communication are essential amongst multidisciplinary team members to ensure that patients are receiving quality care. Lack of communication can lead to poor patient outcomes, low morale, and create mistrusting relationships. A review of evidence has shown that when nursing staff and physician staff communication is seamless there is an increase in patient outcomes. Patient satisfaction, outcomes, and length of stay are expectations in our Comprehensive Stroke Center. The quality of care that patients receive can be determined by the relationship between physicians and nursing staff. Purpose: The purpose of this study is to improve nurse-physician communication during a 6 month period and to identify areas of need with goals to increase patient satisfaction scores and decrease the length of stay of Stroke patients. Action: Daily physician and nursing staff rounds with patients were reconstructed in order to classify responses for patients discharged from Comprehensive Stroke Center from January 2018 to June 2018 based off scores from our Hospital Consumer Assessment of Healthcare Providers (HCAHP) Survey. The questions posed concerning physicians and nursing staff are parallel, and it is imperative that they are both on the same page. Stroke unit nurses were trained and given an in -service by the unit educator in Plan Do Act Check format and rounding tool was implemented. A Stroke Capacity Notification System was continued and fortified to communicate with physician staff and nursing leadership pertaining information on census, transfer, and discharge status of patients via text message every four hours. Results: Communication between physician and nursing staff revealed that engagement scores increased by 11% based on Press Ganey engagement survey. HCAHP Scores increased by 85%. There was a 12% overall decrease in length of stay of stroke population due to collaborative initiative. Practice Implication: Implementation of the daily interactive team rounds and texting will decrease the length of stay, improve physician- nursing communication, and improve patient satisfaction as well as quality of care.

Patient Satisfaction Scores and Standard of Care Compliance in Patients on Biologic Therapy for Psoriasis

Background Under the Affordable Care Act, patient satisfaction scores are used to determine reimbursements. There are limited data studying the correlation of patient satisfaction with physician adherence to standard of care practice. Objective To examine the correlation between patient satisfaction scores and provider adherence to tuberculosis (TB) monitoring in psoriasis patients on biologic therapy. Methods A multicenter retrospective chart review was conducted evaluating physicians’ compliance with TB testing. TB testing compliance was measured and Press Ganey scores of providers from the same time period were obtained. Results The correlation constant among providers was 0.41, suggesting no linear relationship between compliance and patient satisfaction scores. Conclusions This study did not show a correlation between increased patient satisfaction scores and adherence to appropriate medical standards of care. This contributes to the body of evidence suggesting that these scores are an unsuitable determinant of physician compensation. Further studies controlling multiple variables and with greater power are needed.

Sitting at the Bedside Can Improve Patient Satisfaction

To improve the patient experience by having health care providers sit at the bedside. Agreement was reached that all nurses should sit at the bedside to communicate with their patients at least once per shift. Staff deduced that this no-cost and easy to implement change in practice would make a positive difference in patient outlook and would increase patient satisfaction scores. The implementation would improve patient compliance, increase patient–health care provider rapport, and decrease costs and length of hospital stay. Nurse champions collaborated with leaders to educate staff by a train the trainer model. Striving to provide world-class patient care with the implementation of the evidence-based Commit to Sit initiative, monthly satisfaction scores increased from 66.67% to 96.49% in the month after implementation. Results were evaluated through informal leadership audits and patient satisfaction score trending. Positive effects were sustained, and the year ended with an 82.29% satisfaction score (the previous year ended with a score of 71.55%). This program highlights how collaboration between nurse leader and clinical nurses that turns knowledge into action can positively affect patient satisfaction and improve outcomes.

Impact of a discharge prescription program on hospital readmissions and patient satisfaction

ObjectivesMedication nonadherence is prevalent and associated with adverse outcomes, including hospital readmissions. Outpatient pharmacies within health systems are well positioned to intervene and enhance the discharge process by ensuring that patients leave the hospital with all discharge medications. The goal of this study was to evaluate whether a simply designed discharge prescription program (DPP) could reduce readmission rates and increase patient satisfaction scores for participants versus patients who did not participate. MethodsWe conducted a retrospective cohort study across 15 hospital units in a large health system, evaluating inpatient visits from February 2013 to December 2014. Outcomes included the presence of a 7- or 30-day readmission following discharge date and patient satisfaction survey responses. ResultsPatients who participated in the DPP during a hospitalization were significantly less likely to be readmitted than patients who did not participate (P < 0.05). Participation in the DPP decreased odds of 7-day readmission by 20% and of 30-day readmission by 16%. An increase in positive responses for care management and overall experience satisfaction questions was also seen. ConclusionA DPP offers a simple and unique opportunity to reduce readmissions and improve patient satisfaction by dispensing discharge medications before patients leave the hospital.

Nursing Care of the Patient Undergoing an Anterior Approach to Total Hip Arthroplasty.

The anterior, anterolateral, direct lateral, transtrochanteric, and posterior techniques have historically been the surgical approach to a total hip arthroplasty; however, a forthcoming technique called the direct anterior approach has been demonstrated to produce many patient and physician quality outcomes. These favorable outcomes can include shorter hospital stay, earlier mobility and functionality, decreased medical costs, and increased patient satisfaction scores. Appropriate nursing care during the preoperative, intraoperative, and postoperative phases is essential. The purpose of this article is to describe the nursing care for a patient undergoing a direct anterior approach to hip arthroplasty.

Use of a Dog Visitation Program to Improve Patient Satisfaction in Trauma Patients.

Clinical staff members all recognize the importance of attaining high patient satisfaction scores. Although there are many variables that contribute to patient satisfaction, implementation of a dog visitation program has been shown to have positive effects on patient satisfaction in total joint replacement patients. This innovative practice had not previously been studied in trauma patients. The purpose of this quasi-experimental study was to determine whether dog visitation to trauma inpatients increased patient satisfaction scores with the trauma physicians. A team consisting of a dog and handler visited 150 inpatients on the trauma service. Patient satisfaction was measured using a preexisting internal tool for patients who had received dog visitation and compared with other trauma patients who had not received a visit. This study demonstrated that patient satisfaction on four of the five measured scores was more positive for the patients who had received a dog visit.

Pharmacist prescribing within an integrated health system in Washington.

Pharmacist prescribing as part of a collaborative drug therapy agreement (CDTA) within an integrated health system in Washington is described. Virginia Mason Medical Center (VMMC) in Seattle, Washington, uses a team-based care model with broad-based CDTAs to provide quality patient care. The majority of patients are referred to the pharmacist after a diagnosis has been made and a clinical care plan has been started. The pharmacist manages the patient's care within his or her scope of practice as defined by state laws and further detailed by VMMC internal protocols. The pharmacist then documents in the electronic medical record the medication plan of care and other standard elements based on provider note templates. Medication prescribing and laboratory test ordering are the responsibilities of the pharmacist, as are any dosage adjustments or interpretations of laboratory test results. For some chronic diseases, the pharmacist may continue to see the patient indefinitely, replacing physician visits (e.g., for warfarin management). In more episodic care, the pharmacist may see the patient, optimize drug therapy, and then transition the patient back to the referring provider (e.g., for hypertension management). Integrating the pharmacist into the team has helped achieve optimal medication outcomes and increased patient satisfaction scores. The addition of the pharmacist into a team-based care model using a CDTA helped achieve optimal medication outcomes and increased patient satisfaction scores in an integrated health system. Integration was successful due to the collaborative support from physician leadership and ongoing physician involvement. Hands-on leadership by the pharmacy department and clinic directors and the health system's adoption of Lean methodology fostered an environment for developing innovative care models.