Abstracts

Rationale: Seizure monitoring unit (SMU) research typically focuses on its diagnostic utility and optimizing medical management of epilepsy. In order to best achieve these outcomes, it is imperative that the safety and quality of care be optimal. This study reports on an ongoing initiative that uses a standardized assessment tool to measure an important quality indicator of care: patient experience. Methods: The Hospital-Consumer Assessment of Healthcare Providers and Systems (H-CAHPS), a 27-item survey endorsed for use in acute care hospitals by the Agency for Healthcare Research and Quality, is telephone-administered post-discharge to a random sample of patients as part of the standard quality and safety monitoring of care in our setting. Sixty-eight percent of patients from our 4-bed SMU and 10% of General Neurology Unit (GNU) patients are assessed using the H-CAHPS. Key quality indicators measured by this scale include: responsiveness of nursing staff (e.g., after patient call buttons have been pressed), physician communication (e.g., whether doctors invited patients to ask questions about their care), and patient involvement (e.g., whether patients believed they were involved in decisions about their care). Results: Data from a 33 month period (January 1, 2007 - September 31, 2009) were reviewed, encompassing 217 SMU admissions (59.4% women) and 317 GNU admissions (56.2% women). The average age of SMU patients was 14.7 years younger (54.8 years for GNU vs. 40.1 years for SMU, p<.001) and the length of stay 4.2 days longer than for GNU patients (5.5 days for GNU vs. 9.72 days for SMU, p<.001). Across both units, lower education (p<.05) was associated with more favourable hospital experience ratings. SMU patients provided lower overall health (p<.05) and overall mental health ratings (p<.001) compared to the GNU. Regarding our key quality indicators, the SMU patients gave the hospital a better overall rating (p<.05) and the nursing staff were perceived to be more responsive to the call button on the smaller SMU than on the GNU (p<.001). Conclusions: Managing quality by systematically measuring and monitoring key indicators facilitates strategic planning, as well as prioritization of quality improvement and safety initiatives for an SMU. This project demonstrates that using a standardized hospital-based patient experience measure has utility in comparing the standard of care on an SMU to other units. Prospectively assessing patient experience of the SMU over time could assist with providing benchmarks for quality patient-centered care. More work is required to determine the ongoing utility of using H-CAHPS to monitor our responsiveness to patient concerns.