July 10, 2000

Being admitted to the hospital under any circumstance is trying, but encountering spotty care, haphazard service or insensitive staff can make a difficult experience a whole lot worse.

At the UConn Health Center's John Dempsey Hospital, the chances of having an unsatisfactory stay are now greatly reduced.

Since December 1999, the hospital has been conducting a survey to obtain patients' reactions to their care and put the information into the hands of decision makers within 24 hours. The program, known as the Official Husky "Service Rater," asks patients 10 questions related to their hospitalization. Responses are on a five-point scale, 5 being excellent.

The program was designed to get feedback to care-givers immediately so that they can make changes where needed.

"We're always looking for opportunities to improve," said Ann Smith, director of patient relations, the office that designed and conducts the survey, "and the survey is a means to that end. We want to find out right away what we're doing well so we can continue to do that."

The Dempsey Hospital subscribes to the standard hospital survey and information service, Press-Gainey. When the reports come back from the company, months could have passed. Nursing managers and hospital administrators needed something more immediate. So they made their own survey.

"We want to ensure that the patient experience is as good as possible," said Steven Strongwater, associate dean for clinical affairs. "We need the information while they are in the hospital, not after they go home. The Husky Rater System helps us reach this goal."

Surveying starts on the second day of the patient's stay. Two patient relations volunteers - Karen Ellsworth and Dorothy Martino - visit the floors to interview the patients. They bring the information back to staffer Laurel Mancini, who assesses and codes it and sends it on to the nursing manager and hospital administrators.

The questions address patients' opinions, attitudes and some observables: "Do you feel that you are involved in your plan of care?" "Do you feel as if you are treated with respect and dignity by staff?" "Is your room clean and pleasant?"

Actions or reactions depend upon the response. The survey early on revealed that patients were uncomfortable and lacked knowledge about the discharge process and what happens to them when they go home. The hospital routinely plans for post-discharge care - case managers coordinate services such as rehabilitation or physical therapy; visiting nurse care, prescriptions and follow-up visits to the doctor - but patients reported that they were uninformed.

The solution was simple: staff and nurses should talk more about what happens after discharge. "We made it a point to be more overt," said Smith. "The survey made clear the patients were not as informed as we thought they were. There was always a great deal of planning for post-discharge care, but it wasn't something we did in front of the patients. Now we make it a point to talk more about discharge and after-care and to keep the patients fully informed."

Often the survey reveals not shortcomings, but staffers and nurses doing extraordinary things that patients want to commend. The survey gives them an opportunity to do that.

"It's been very positive," said Anne Horbatuck, the nurse manager

of a surgical floor. "I post them so staff can read them. Patients use the survey to remark on the wonderful care they received. So not only do we get immediate feedback, often we get very positive feedback for the care we're delivering."

To date, more than 200 patients have participated. The survey is conducted on three floors: Medicine4, Cardiac Surgery and Surgery7, selected because their patient census was consistently the highest. The hospital is considering extending the survey to other floors.

One concern administrators had in planning for the survey was: Would patients respond candidly? Might surveying patients under care cause them to be non-committal, believing that "wrong" answers could jeopardize the level and intensity of the care they received?

The experience is: They're candid. From the time they're admitted, patients are told they are going to be surveyed immediately to find out how their service is. They're told they are free to tell it all in the survey - good and bad - and if there's something that needs fixing, then the survey is the way to do it.

Pat Keefe