Evaluation of a nurse practitioner-led project to improve communication and collaboration in the acute care setting

Background: Effective communication between patients and the health care team is essential. The Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey measures discharged patients' perceptions of their hospital experience, including nurse and doctor (physician) communication. These scores affect hospital reimbursement for Medicare and Medicaid patients. Local problem: In 2015, the project facility was penalized for low HCAHPS scores, causing a loss in revenue. The facility's medical-surgical unit scores were still failing in 2016. Methods: A quality improvement project on Interprofessional Bedside Rounds (IBR) was designed and implemented, and the effect of hiring nurse practitioners (NPs) to the unit's hospitalist service was also examined. Analysis of variance was used to detect significant changes in nurse and doctor HCAHPS communication scores from baseline in 2016, after NPs were hired in 2017, and post-IBR in 2018. The Interprofessional Collaborative Competency Attainment Scale (ICCAS) was also used to measure changes in staff competencies. Interventions: The IBR intervention was conducted with the NP, nurse, and doctor present. It was structured to promote effective communication and patient engagement. Results: Hospital Consumer Assessment of Health Care Providers and Systems scores improved, with nurse scores increasing from 2016 (79%) to 2017 (86%) to 2018 (90%) (p = .310). Doctor scores improved from 2016 (69%) to 2017 (88%) but slightly decreased to 2018 (85%) (p = .040). Interprofessional Collaborative Competency Attainment Scale results showed a 29% improvement in staff's perceived ability to collaborate (p = .000). Conclusions: Results indicate that the addition of NPs greatly improved HCAHPS communication scores. To improve communication, medical-surgical units should consider a team-based approach that includes NP leadership for implementing evidence-based interventions such as IBR.