Download: Summary – HCAHPS Best Practices in High Performing Critical Access Hospitals Study

There are many ways to increase your HCAHPS scores as detailed in the article above. One problem that plagues many small hospitals is that they have trouble getting patients to fill out the surveys. This issue can be addressed by telling the patient several times during their stay to expect a survey. Moreover, other hospitals give out an HCAHPS reminder brochure or place survey information on televisions in the patient rooms.

One method to increase the patient’s opinion on communication between the patient and the nurse is to have the nurses use keywords during patient interactions and education. The use of keywords helps the patient associate the education they received with the questions on the survey. The responsiveness of the staff is another area that is addressed in the HCAHPS. Therefore, having everyone—not just nurses—respond to call lights may increase this score. Pain management is another area that can be improved. Setting realistic expectations for pain control as well as providing alternative therapies can increase patient comfort while decreasing their dependence upon pain medication.

Medication communication is another area where hospitals can improve HCAHPS scores. A strategy of high performing hospitals is to have the Pharmacist visit the patient to review their medication, reinforce the prescribed dosing schedule, as well as answer any of the patient’s medication questions. Ensuring that the patient feels that their room is clean is very important. This can be done by making the patient is aware of the cleaning services performed before and during the stay as well as performing random cleanliness audits. A final area surveyed by HCAPHS is the discharge information and care transitions. Usually, satisfaction can be improved by calling the patient after discharge to review discharge instructions and address any patient or caregiver questions that might have come up.

The Outpatient Domain currently made up of four different measures.  The first area focuses on the treatment of Acute Myocardial Infarction and consists of two different measures.  If indicated, is Fibrinolytic Therapy received within 30 minutes of arrival is the first measure.  The second measure looks at the time it takes to transfer a patient to another facility for Acute Coronary Intervention.  The second area of focus is Emergency Department throughput.  This area is measured by the median time from ED arrival to ED departure for Discharged patients and the final measure is the number of ED patients that left without being seen by a provider per year.

The Patient Safety/Inpatient Domain consists of two main measures—Influenza Vaccination of Healthcare Workers and participating in the annual Antibiotic Stewardship Survey (which is part of the National Healthcare Safety Network (NHSN) Annual Survey).

The Centers for Disease Control and Prevention has done a review of published literature and indicates that influenza vaccination of health care personnel can enhance patient safety.  Health care personnel have the potential for exposure to patients and/or to infectious materials, whether or not directly involved in patient care. 

The Antibiotic Stewardship Survey evaluates the hospitals on the strength of their Antibiotic Stewardship program with a focus on seven Core Elements.  The core elements include Leadership commitment, Accountability, pharmacist input/leadership, implement intervention to improve antibiotic use, monitor patterns, report the information to prescribers, pharmacists, and hospital leadership, and finally providing education on antibiotics to providers, nurses and patients.  There are multiple ways that each of these domains may be addressed by the healthcare facility.  More information can be found at:

The Core Elements of Hospital Antibiotic Stewardship Programs (

The Emergency Department Transfer Communication (EDTC) was originally developed by Stratis Health and the University of Minnesota Rural Health Research Center in 2004. Both partners met again in 2108 to review and update the measure. The new version of the EDTC measure went into place first quarter of 2020.