Background: New models of healthcare delivery and reimbursement are emerging and place a high emphasis on improving the quality of care provided to patients and the experiences of the patient or patient’s family. Providing high-quality care and measuring and obtaining high patient satisfaction scores is critical to patient outcomes. Good patient experience is tied to better patient outcomes, higher financial performance, fewer malpractice risks, and increased patient loyalty. The role of the RN in patient experience, care coordination, and patient education is substantial, specifically in the ambulatory care setting. At UK HealthCare, the pediatric twilight clinic (an urgent treatment center for pediatrics) historically received low patient satisfaction scores. The addition of two new RNs in care coordination roles (implemented in July 2018) to the clinic positively impacted patient experience and care coordination scores.
Methods: Job descriptions were created for the RN roles and included various responsibilities such as direct patient care, care coordination, education, and professional development. Under the care coordination job responsibility, an emphasis was placed on the importance of follow-up phone calls to the child’s guardian or caregiver after the child’s visit to the clinic. During the follow-up phone call, the RN assesses and monitors the current health status of the child, provides follow-up care instructions (if appropriate), follows up on test results, and asks about the guardian or caregiver experiences in the clinic with a series of defined questions and statements. The RN acts as the point person for the child’s caregiver and aids in answering any questions and provides specialized education. The RNs work collaboratively with the pediatric physicians who assess, diagnose, and treat.
The Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) is a standardized survey that UK HealthCare uses to measures patient perceptions and experience of care delivered by healthcare providers (physician, nurse practitioner, physician assistant, etc.) In addition, the survey asks specific questions about patient experiences with nursing staff and degree of care coordination provided. The CG-CAHPS data was utilized to interpret baseline data before the implementation of the new RNs and after the implementation of the new RNs.
Results: Since July 2018, there were over 1200 patient charts reviewed and follow-up phone calls made. Patient experience scores improved 2 months post-intervention. Prior to the intervention, the overall care coordination score for CG-CAHPS was 78.4%, and post-intervention the score was 100%. In addition to the improvement in care coordination, there was also improvement in questions specific to nursing staff. The questions for nurses’ follow-up care instructions and nurse prompt answer to phone question showed improvement. Numerous positive comments from patients’ caregivers were recorded during phone calls in addition to the improvement in scores.
Conclusions: The addition of RNs in a care coordination type role into an ambulatory care clinic positively impacted patient satisfaction scores, particularly in the care coordination domain. The further addition of this RN role could positively impact other clinics, leading to higher patient satisfaction scores and improved patient outcomes.