Hospitals Encouraged to Examine Their Approach to Isolation

In a concise communication published in the May 2012 issue of Infection Control and Hospital Epidemiology,  Joan Vinski, MSN, RN, CIC, Mary Bertin, BSN, RN, CIC, Zhiyuan Sun, MS, Steven M. Gordon, MD, Daniel Bokar, James Merlino, MD, and Thomas G. Fraser, MD, report on their measurement of the impact of isolation on patient satisfaction.

The researchers used the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to measure the effect of  isolation on patient satisfaction. Isolated patients reported lower scores for questions regarding physician communication and staff  responsiveness. Overall scores for these domains were lower in isolated than in nonisolated patients.

As Vinski, et al. (2012) explain, "Acute care hospital infection prevention programs commonly employ isolation practices to prevent cross-transmission of pathogens. Isolation has been recognized as having deleterious effects on patient throughput, safety, care, emotional well-being, and hospital  costs; methods to measure these effects are lacking. The Center for Medicare and Medicaid Services (CMS) measures patient  satisfaction using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Hospitals subject  to the CMS Inpatient Prospective Payment System must collect and submit HCAHPS data. These data will comprise 30 percent of a  hospitals value-based purchasing score in CMS fiscal year 2013. "

The researchers note further, "This comparison of HCAHPS responses found an association between isolation and lower scores for physician communication and staff responsiveness. A trend toward lower scores was also seen for nursing communication and pain management. Isolation was also associated with a trend toward a deleterious effect on the patients perception of cleanliness and their willingness to recommend the hospital."

They add, "Isolation precautions are tools that benefit a hospitalized population and healthcare workers rather than the individual isolated. The inclusion of HCAHPS results in a hospitals value-based purchasing score raises the visibility of all procedures influencing a patients hospital experience, including environmental cleanliness and infection prevention protocols. This heightened awareness is an opportunity for infection prevention programs to reinforce reasons, adherence, and execution of isolation practices. It also compels infection prevention to examine their approach to isolation, assessing its impact on the totality of patient care and assuring that this tool is used judiciously."

Reference: Vinski J, et al. Impact of Isolation on Hospital Consumer Assessment of Healthcare Providers and Systems Scores: Is Isolation Isolating? Infection Control and Hospital Epidemiology.  Vol. 33, No. 5, May 2012.