OR Manager - November 2018 - 28

AMBULATORY
SURGERY CENTERS
Continued from page 27
the survey. To date, only 22 survey
vendors are certified for more than
6,000 ASCs in the country (https://
oascahps.org/General-Information/
Approved-Survey-Vendors).
The dearth of certified vendors is
one reason to consider implementing
the survey before it becomes mandatory.
ASC leaders and CMS sources say
it is important to talk to at least three
vendors before signing any contracts.
The prices for vendors and their services
are not equivalent.
CMS does not approve what vendors
charge or any additional services they
may include beyond what is required,
CMS sources say.
" Cost varies by vendor and the
scope of work, as well as the number
of surveys distributed, " George says.
" We are having our vendor develop additional
reports for our company, so that
Simple changes net higher numbers
on recovery questions
Voluntary implementation of the Consumer
Assessment of Healthcare Providers
and Systems Outpatient and Ambulatory
Surgery Survey (OAS CAHPS) at the
Northwell Health Center for Advanced
Medicine (CFAM) Ambulatory Surgery
Center, part of the Long Island Jewish
Medical Center in New Hyde Park, New
York, began in 2017. Leadership wanted
the early adoption so as to be fully prepared
before OAS CAHPS becomes mandatory
for all ambulatory surgery centers
(ASCs), says Ellen Carpenter, BSN, RN,
nurse manager.
Early action has already paid off
through the development of better discharge
instructions, leading to higher
patient satisfaction scores.
Recovery is one of five categories
represented in OAS CAHPS. Nine of the
37 questions on OAS CAHPS focus on
recovery. The first is: " Did your doctor
or anyone in the facility prepare you
for what to expect during your recovery? "
Subsequent questions ask about
nausea, vomiting, pain, infection, and
bleeding.
Practical and pretty
Recovery-related scores among Northwell
Health's patients were not as high
as anticipated-only 80%. Recognizing
that perhaps patients needed better
discharge instructions, staff formed a
task force to work on a solution. Within
3 months of replacing old discharge
instructions with a new and improved format,
leaders saw an increase in scores for
recovery-related questions from 80.5% to
95%.
The improvement came not from large,
costly changes, but rather from common
sense, patient-centered modifications to
information that was already being provided
to patients after surgery.
The idea for the changes came from
staff nurse Susan Miller, BSN, RN, a member
of the patient experience committee.
Her suggestions were embraced by Maureen
Early-Donohue, MSN, RN, senior administrative
director, patient and customer
experience, Long Island Jewish Medical
Center, and a task force was formed.
The task force created a discharge
folder with handouts outlining detailed
information about the possibilities of
pain, nausea, bleeding, and infection
following surgery and what to do if those
things happened. On the second side
of the folder, a handout was created for
surgeons' direct discharge instructions for
the patients' particular type of surgery and
related side effects.
The handouts were designed using the
latest information on health literacy in a
colorful, easy-to-navigate format that patients
were less likely to toss in the trash
when they went home.
The previous discharge instructions were
provided on a one-page, uninspired handout
with small type and did not mention
bleeding or infection. The low OAS CAHSP
scores revealed the original handouts were
not as helpful to patients as they were
meant to be.
The new folders were distributed to
patients beginning in October 2017. But
to reinforce the instructions, they are discussed
during presurgery calls to patients.
Some patients cannot fully absorb information
at the time of discharge because their
memories may be impaired by anesthesia.
Family or friends who are with them at the
time may not accurately remember the details,
either.
Sustaining the gains
Despite the jump in patient satisfaction
scores to 95%, team members did not
rest on their laurels. To sustain the high
score, surgical team members track an
OAS CAHPS scorecard to monitor any
significant changes, and they check in
weekly with frontline staff and monthly
with ASC leadership.
Gloria M. Collura, MSN, RNC, senior
administrative director ll, patient care services,
perioperative services, at Northwell
CFAM ASC, offers this advice for anyone
wishing to make similar improvements in
OAS CAHPS scores:
➤ know your data from your ASC's OAS
CAHPS scores
➤ start with a simple goal
➤ use teamwork.
Because of the success regarding recovery
and discharge, team members involved
with anesthesia are examining ways to improve
their OAS CAHPS scores as well.
28
OR Manager | November 2018
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OR Manager - November 2018

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