Using Teach-Back Guided Patient Education to Improve HCAHPS Scores

Abstract

Ineffective communication practices, including patient education and discharge planning, that fail to inform patients in clear terms, do not adequately satisfy patient expectations. Recent changes that affect provider reimbursement have largely been the impetus for greater emphasis on identifying best practices for efficient communication. The benchmark patient satisfaction survey, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), uses seven distinct composite areas, including satisfactory nurse-patient communication, to make fair comparisons about performance from the patients’ perspective. The purpose of this project was to measure the impact of nurse-patient communication on patient satisfaction as evidenced by HCAHPS scores. This quality improvement project (regarding this educational intervention) used a convenience sample of 21 staff registered nurses (RN) on an immediate care unit (IMCU). Slide style presentations were performed using standard Microsoft PowerPoint (PPT). Each participant completed a 15-20 minute PPT presentation led by the principal investigator (PI) on the intervention of teach-back (TB) as well as pre- and post-testing. TB was later used by staff RNs for patient education specific to discharge planning and new medications. Select HCAHPS items specific to nurse-patient communication were subsequently used to measure changes in patient satisfaction. The PI-led training sessions were TB refresher sessions for this group who had completed employer-mandated TB training 6 months earlier. TB training was found to yield significant improvements in staff RN knowledge in post-testing (Z=3.044; p=.002) and (remediation) post-testing (t(20)=6.92; p

Resulting HCAHPS scores did demonstrate a trend of improvements; however, these findings were not statistically significant. Similar findings of improved HCAHPS scores were noted following mandated training; these results were also not significant. The use of TB training alone is not sufficient to remedy problems related to patient satisfaction regarding nurse-patient communication. Combining TB with better developed patient education practices must be used to efficiently address patient satisfaction. Examples of better developed patient education practices include input from pharmacy, simply printed medication materials listing indications and side effects, and bedside rounding that includes the patient feedback. Recommendations for future research should include how mixed and more robust patient education practices influence patient satisfaction.