CAHPS Child Hospital Survey (Child HCAHPS) Toolkit

Hospitals have utilized data from Child HCAHPS survey results and related survey measures to support and track efforts to improve patient and family experience in the inpatient pediatric setting. Below is a selection of case studies and articles about improving patient experience for pediatric patients and their families.

Case studies and articles are organized by the following sections:

• Improving Communication With Providers.
• Preparing Families for Discharge.
• Engaging With Patients and Families To Improve Pain Management.
• Other Inpatient Pediatrics QI Initiatives and Case Studies.
• Additional Research Reports and Case Studies Using CAHPS Survey Data.
• Information About QI Strategies To Improve Patient Experience.

The Center of Excellence for Pediatric Quality Measurement (CEPQM) team authored an article in Pediatrics that was published in 2020 about key drivers associated with patient and family experience during inpatient care. Select to access the article (PDF, 1.5 MB).

Improving Communication With Providers

Improving Communication with Nurses Using a Communication Bundle Strategy

In this quality improvement (QI) initiative, a communication bundle strategy intervention was utilized to enhance nurse communication and improve patient satisfaction at an inpatient orthopedic/hematology unit in a Mid-South children’s hospital. The use of best practice communication strategies, including nurse bedside shift reporting, whiteboards, and scripting resulted in improved Child HCAHPS scores on communication at the bedside and parents’ perception of nurse-child communication.

Parent and Provider Experience and Shared Understanding After a Family-Centered Nighttime Communication Intervention

A family-centered, multidisciplinary nighttime communication intervention (nurse–physician brief, family huddle, family update sheet) was utilized to improve experience with communication and shared understanding with providers. Top-box parent experience improved for 1 of 4 domains: Experience and Communication With Nighttime Doctors (p<0.05). Top-box provider experience improved for all 3 domains, including Communication and Shared Understanding With Families, and Experience, Communication, and Shared Understanding With Other Providers (p<0.05).

Utilizing Personalized Provider Cards to Improve Patient/Doctor Connections

Children’s National Medical Center implemented personalized provider cards with pictures and biographies of doctors, as well as an explanation of provider roles to enhance patient and family connections with providers. Following the intervention, there were improvements in Child HCAHPS metrics, including doctors explaining things in a way that was easy to understand, and overall likelihood to recommend the hospital.

Preparing Families for Discharge

Using Technology and Empathy to Improve Patient Experience

This case study discusses strategies used to improve patient experience at the new University of Iowa Stead Family Children’s Hospital. High tech patient engagement platforms were implemented in each room of the inpatient units, including computer tablets on bedside tables, and large screen TV displays used for entertainment and to view educational videos about diagnoses/treatment. Experience improved on Child HCAHPS measures of Likelihood to Recommend, Receiving Instructions for Home Care, Providing Condition/Treatment Information, and Families Feeling Ready for Discharge. Since the opening of the new hospital, including the implementation of the bedside patient engagement platform, the mean satisfaction score rose from 74.8 percent (95% CI = 72.7 to 76.8) to 82.8 percent (95% CI 80.3 to 85.3).

A QI Collaborative to Improve the Discharge Process for Hospitalized Children

In this multicenter QI collaborative with 11 tertiary-care freestanding children’s hospitals, interventions and subsequent Plan-Do-Study-Act (PDSA) cycles were implemented to improve discharge planning, quality of discharge instructions, and post-discharge support. Following the intervention, there were lower rates of discharge-related care failures, decreasing from 34 percent in the first quarter of the project to 21 percent at the end of the collaborative (p<0.05). Family readiness for discharge improved from 85 percent of families reporting the highest rating to 91 percent (P < .05). There was no improvement in unplanned 72-hour (0.7% vs 1.1%, P = .29) and a slight increase of the 30-day readmission rate following the collaborative (4.5% vs 6.3%, P = .05).

Engaging With Patients and Families To Improve Pain Management

Improving Satisfaction with Pediatric Pain Management by Inviting the Conversation

Nurses on rounds at the Lucile Packard Children’s Hospital asked a standardized question about how well a child’s pain was being controlled. Patients who received the intervention reported a higher satisfaction with pain management than those who did not (p<0.0001).

Leveraging Interactive Patient Care Technology to Improve Pain Management Engagement

Interactive technology was used to stimulate conversations about pain treatment plans, expectations, and perceptions of plan effectiveness on a pediatric surgical unit and hematology/oncology unit of a free-standing children’s hospital. Plan-Do-Study-Act cycles were utilized to integrate the technology system with medication dispensing and the electronic health record. Proportion of positive family satisfaction responses for pain management significantly increased from 2014 to 2016 (p=0.006).

Other Inpatient Pediatrics QI Initiatives and Case Studies

Access to the case studies below requires a paid membership. You will be directed to the Beryl Institute home page regarding next steps.

1. A Framework for Improving Parent Satisfaction with the Inpatient Pediatric Admission Process: The Aga Khan University Hospital
   1. Intervention: Messages delivered within 1 hour of inpatient admission, training providers to reduce parental anxiety related to hospital admissions, inform parents regarding basic amenities.
   2. Outcome Measure: Overall satisfaction with admission process improved, patient anxiety score within 24 hours of admission decreased.
2. Patient Navigation in Pediatrics: A Promising Practice for Eliminating Healthcare Disparities at Seattle Children’s Hospital
   1. Intervention: Patient navigators who speak families’ language were available to remove barriers to timely, safe, and effective care for Somali- and Spanish-speaking families and their children with chronic/complex medical needs.
   2. Outcome measure: Inpatient admission rates were lower for children after their involvement with patient navigators as compared to before they were a part of the program. The average length of stay for children with admissions was lower after their involvement with patient navigators as compared to before.
      1. Children with navigators had a lower proportion of missed opportunities for care than they did before their involvement with the program and as compared to children in their same language groups without navigators and to the English-speaking Medicaid population.
3. Designing Technology Solutions to Improve the Patient Experience: Phoenix Children’s Hospital
   1. Intervention: Imaging innovations to reduce patient anxiety and improve image quality, making videos to show children how the imaging process works.
   2. Outcome Measure: Patient experience surveys.
4. Navigating Your Way to a Better Patient Experience: Children’s Healthcare of Atlanta
   1. Intervention: Mobile App to improve care coordination, give directions in hospital, links to pharmacies, access mobile chart, view wait times at urgent care.
   2. Outcome Measure: More than 9,000 downloads, 76% users returned to app, improved patient experience and workflow.
5. Increasing Patient Comfort and Reducing Anxiety through Movie Entertainment: Arnold Palmer Hospital for Children
   1. Intervention: Customized, multi-channel patient engagement content broadcast in patient rooms and throughout the hospital.
   2. Outcome Measure: Program expanded to 7 channels across three hospitals, positive reports from patients, families, staff.
6. Engaging with Patients and Families by Creating a Virtual Advisory Council: Nemours
   1. Intervention: Creation of Virtual Advisory Council with families who had received care at Nemours, expanding feedback beyond physical family advisory councils.
   2. Outcome Measure: Actionable improvement to senior management, process improvement workshops.
7. Building an Expanded Patient Experience Program: Women and Infants
   1. Intervention: Restructuring Patient and Family Centered Care Program to include Patient and Family Advisory Councils, patient relations, patient and guest services, interpretation services, patient and family experience team with four key roles.
   2. Outcome Measure: Numerous initiatives to integrate hospital services and improve patient experience.

Additional Research Reports and Case Studies Using CAHPS Survey Data

Accessible on the AHRQ website at https://www.ahrq.gov/cahps/quality-improvement/reports-and-case-studies/index.html.

Information About QI Strategies To Improve Patient Experience

1. Quigley DD, Palimaru A, Lerner C, Hays RD. A Review of Best Practices for Monitoring and Improving Inpatient Pediatric Patient Experiences. Hospital Pediatrics 2020;10(3):277-285. doi:10.1542/hpeds.2019-0243.
2. The CAHPS Ambulatory Care Improvement Guide: Practical Strategies for Improving Patient Experience (PDF, 3.7 MB). Content last reviewed February 2020. Agency for Healthcare Research and Quality, Rockville, MD.
3. Ways To Approach the Quality Improvement Process (Section 4 of CAHPS Ambulatory Care Improvement Guide) (PDF, 487 KB). Agency for Healthcare Research and Quality, Rockville, MD.