Guadalupe Regional Medical Center Case Study

At the heart of Guadalupe Regional Medical Center’s culture is a spirit of collaboration, consideration, and continuous striving toward improvement. Listening to patients and staff to institute meaningful changes is known as “the GRMC way.”

The 125-bed not-for-profit community hospital serves the city of Seguin, Texas, and the surrounding eight-county area, admitting nearly 5,000 patients annually. To be sure GRMC patients receive the best care throughout their stays, the staff uses rounding practices to gather immediate feedback about what’s working well and what’s not.

Like many hospitals, GRMC needed a more efficient and actionable way to gather as much vital information as possible during the rounds, including understanding and addressing the changing needs of each patient, identifying trends within each hospital unit, and swiftly dealing with any systematic issues as they arise.

Improving the rounds directly leads to increased attentiveness to patient needs, improved patient experience, higher patient satisfaction, and an overall happier healing environment. More satisfied patients means higher HCAHPS scores, which, in turn, boosts both hospital reimbursements and the hospital’s bottom line.

Challenging the Pace of Change

In the past, patient and staff rounds at GRMC were paper-based, which created many logistical issues. It was difficult to be sure that patients’ needs were quickly being addressed. Requests and feedback from patients and staff were difficult to track. In addition, the process of aggregating information for reporting and analysis was manual and labor-intensive, contributing to a cumbersome workload for the hospital’s patient experience coordinator.

GRMC leaders knew they needed a more responsive rounding process and a way to automate and accelerate the flow of patient and staff rounding data. They also needed the ability to spot and analyze trends and generally track the rounding process.

After a thorough assessment, GRMC found its solution: Vocera® Rounds. This solution is a secure, configurable software-as-a-service platform for patient and staff rounding that is tailored to hospital goals and industry best practices. As part of the implementation process, Vocera and GRMC teams worked together to incorporate the established GRMC communication framework into the solution.

“It’s important for us as an organization that any model or tool we adopt fits into the GRMC way,” says Elizabeth Pastrano, patient experience coordinator. “Vocera actively worked with us, accommodated our questions, and helped us ensure the solution was aligned with our culture, values, and goals.”

“I can’t say enough about our partnership with Vocera,” says Daphne Blake, chief nursing officer. “We appreciate how willing Vocera has been to tailor the system and ensure that the finished product is truly a representation of GRMC.”

With Vocera Rounds in place, patient feedback collected during rounds is quickly aggregated for review during department meetings. Using this forum, teams evaluate their practices in light of patient experiences and identify potential ways to improve. Staff rounding data also provides information for management self-assessment.

Improving Patient Experience through Proactive Rounding

GRMC nurse leaders use Vocera Rounds to anticipate patient needs and improve their experience, which has decreased the number of alerts in the nurse call system. During the rounds, nurse leaders ask patients about the reasons for their previous nurse calls and compare those responses to call logs. This gives them a way to identify issues of particular importance to patients in each unit: toileting in the in-patient rehabilitation unit, for instance, or pain management in the surgical unit. Huddle board discussions then compare the words and phrasing different team members use to address the issues.

“Some of our staff were asking, ‘Do you need to go to the bathroom?’ which was more of a suggestion,” recalls Pastrano. “Others would say, ‘While I’m in here, let me get you up and take you to the bathroom.’”

By standardizing the more assertive phrasing, nurses are able to proactively address patients’ needs, avoiding urgent issues later on. As a result, nurse calls are decreasing while patients are more satisfied with their care, as evidenced by both rounding responses and HCAHPS scores.

Boosting Key HCAHPS Scores

After adopting Vocera Rounds in January 2015, GRMC patient satisfaction scores in key HCAHPS domains rose steadily (see Table 1). For example, pain management scores improved across multiple hospital units, contributing to an overall improvement of 11.8 percent since inception.

In addition, although not specifically part of its rounding solution service goal, GRMC has seen an increase in the number of patients who rated the hospital very highly (9 or 10 on a scale of 1–10).  GRMC is already seeing national percentile ranking improvements in several areas including communication with nurses, responsiveness of staff, pain management, and communication about medications (see Table 2).

Accelerating Care Improvements with Real-Time Rounding Data

Now that patient experiences are recorded electronically throughout the day, the hospital can use the information to make improvements much more quickly than when it relied on either handwritten records or on HCAHPS surveys patients complete after discharge.

“The HCAHPS scoring data can have quite a long delay, so having current rounding data for our huddle board processes allows us to affect change much more quickly,” says Pastrano. “With Vocera Rounds, we have the opportunity to make a real impact on the patient experience while they are still here in the hospital and also ensure we are making the right interventions.”

Improving Staff Satisfaction by Building Deeper Relationships with Hospital Leaders

Managers at GRMC also conduct regular staff rounds to check in on their employees’ experiences. Topics range from equipment needs to process improvements, as well as staff assessments of leadership, personal inquiries, and awards and recognition.

“One-on-one conversations are so important in our effort to be more transparent and to build better relationships based on two-way communication,” says Blake.

“Being recognized for your performance by your patients and your director is really an important factor in staff satisfaction and engagement,” continues Blake. “That’s something that we’ve always focused on as part of our culture, and it’s been impressive to see how many of these opportunities we’ve captured through Vocera Rounds.”

Building the Future on Communication and Collaboration

GRMC continues to fine-tune its use of Vocera Rounds to fuel process improvements and ultimately ensure the hospital continues to provide high-quality care to its patients.

“We are still moving forward, and we will continue to look to the collaboration between our process improvement and patient experience teams for the solutions that will enable our success,” says Blake.

At the same time, the hospital is deploying Vocera Collaboration Suite to enable secure messaging among physicians and care team members. “We’re thankful for the tools that Vocera makes available to help us improve,” says Blake. “Their flexibility in listening and incorporating our ideas has made for a strong relationship, and it’s really helping us to maximize the positive impact for our patients.”

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