HCAHPS updates are going into effect on January 1, 2025, with the most substantial HCAHPS changes we have seen in a long time.
Key Changes
- The addition of three new Web-First modes of survey administration (Web – Mail [web followed by mail], Web-Phone [web followed by phone], Web-Mail-Phone [web followed by mail followed by phone])
- New and updated questions and response categories
- Requirement for hospitals to provider their survey vendor information regarding the language the patient prefers to speak while hospitalized
- Requirement for hospitals to use the official Spanish translation of the HCAHPS Survey for Spanish language-preferring patients
- Extension of the data collection period from 42 calendar days to 49 calendar days for all modes
- HCAHPS responses will be allowed by patient’s proxy
- Supplemental items will be limited to a maximum of 12 added to the end of the HCAHPS Survey
- Survey instrument increased to 32 questions from 29
HCAHPS questions removed from the NEW survey instrument:
- During this hospital stay, after you pressed the call button, how often did you get help as soon as you wanted it? (Previous question number 4)
- During this hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left. (Previous question number 20)
- When I left the hospital, I had a good understanding of the things I was responsible for in managing my health. (Previous question number 21)
- When I left the hospital, I clearly understood the purpose for taking each of my medications. (Previous question number 22)
- During this hospital stay, were you admitted to this hospital through the Emergency Room? (Previous question number 23)
HCAHPS questions added to the NEW survey instrument:
- During this hospital stay, how often were you able to get the rest you needed? (NEW question number 8)
- During this hospital stay, how often were doctors, nurses and other hospital staff informed and up to date about your care? (NEW question number 10)
- During this hospital stay, how often did doctors, nurses and other hospital staff work well together to care for you? (NEW question number 11)
- During this hospital stay, when you asked for help right away, how often did you get help as soon as you needed? (NEW question number 14)
- During this hospital stay, did doctors, nurses and other hospital staff help you rest and recover? (NEW question number 18)
- Did doctors, nurses or other hospital staff work with you and your family or caregiver in making plans for your care after you left the hospital? (NEW question number 19)
- Did doctors, nurses or other hospital staff give your family or caregiver enough information about what symptoms or health problems to watch for after you left the hospital? (NEW question number 20)
- Was this hospital stay planned in advance? (NEW question number 26)
The new survey continues with the focus on responsiveness of staff and comprehensive discharge planning. New to this survey, there are questions designed to understand the patients’ perspectives on the rest and recovery they experienced, how staff communicated information and if there was collaboration of staff regarding the care the patient received. Specifically:
- During this hospital stay, how often were you able to get the rest you needed?
- During this hospital stay, did doctors, nurses and other hospital staff help you rest and recover?
- During this hospital stay, how often were doctors, nurses and other hospital staff informed and up to date about your care?
- During this hospital stay, how often did doctors, nurses and other hospital staff work well together to care for you?
What actions can we take to proactively address these four new questions?
Rest and recovery can be associated with quietness around the room and quietness at night but in addition, the patients’ perspective of rest and recovery may also be influenced by other actions we intentionally take to demonstrate we are concerned about their rest and recovery.
Consider these potential opportunities ~
- Ask the patient or family member if they would like the door to be closed to provide a quieter environment
- On admission, ask the patient or family member if there is a particular time of the day they prefer to nap or would rather bathe in the effort to create an individualized plan of care
- Use “Quiet Zone” signs and reminders in the corridors and add a card at the bedside describing this activity with the goal of providing a restful environment
- Eliminate use of overhead paging, particularly at night
- Designate zones for staff conversation (e.g., nurses station) to help avoid hallway discussions that may be disruptive to nearby rooms
- Evaluate transport carts and replace noisy wheels and casters
- Turn down the alarm sound level on monitoring equipment if feasible or have telemetry equipment monitoring away from the patient (e.g., in the nurse’s station)
- Consider purchasing “quiet packs (eye masks, ear plugs, etc.)” and provide upon admission
- Request that work involving heavy machinery only be done during the daytime (e.g., use of battery powered scrubbers, buffers, and other loud equipment
- In the evening/nighttime, use a flashlight to illuminate what is needed in the patient room rather than turning on the overhead lights when the patient is resting
Demonstrating that staff are working well together and being informed and up-to date- about care will take intentional coordination. Patients and family members appreciate knowing that their care team is communicating with each other and are ensuring proactive management of all elements of their care plan.
Consider these potential opportunities ~
- On admission, explain to the patient and family members the process for “Bedside Reporting.” If the patient agrees, invite family members to attend as well. Provide information about “Bedside Reporting” in the admission packet and visibly placed within the room.
- Utilize the SBAR format or something similar throughout the organization to standardize all warm hand-off reporting opportunities, including providers.
- Ensure staff are receiving training during orientation regarding warm hand-off and monitor the adherence to this expectation.
- Provide staff training and promote awareness relating to empathy and effective communication including both patient/family and staff communication practices
- Implement peer to peer mentoring and feedback
- Use teach-back, limit jargon/technical terms and employ other health literacy principles such as Ask Me 3
- Engage patients and families in care conferences and/or interdisciplinary rounds
- Use scripting for key messages and/or employ a communication framework such as AIDET
- Provide pads/pens at the bedside for patients and family members to jot down notes and ensure all nursing staff and providers ask the patients/family members if they have any notes of questions or concerns, they have.
The NEW standardized 32-question HCAHPS Survey instrument is composed of the following elements:
Composite Measures (7)
- Communication with Nurses (comprised of three HCAHPS Survey items)
- Communication with Doctors (comprised of three HCAHPS Survey items)
- Restfulness of Hospital Environment (comprised of three HCAHPS Survey items)
- Care Coordination (comprised of three HCAHPS Survey items)
- Responsiveness of Hospital Staff (comprised of two HCAHPS Survey items)
- Communication About Medicines (comprised of two HCAHPS Survey items)
- Discharge Information (comprised of two HCAHPS Survey items)
Individual Items (2)
- Cleanliness of Hospital Environment
- Information About Symptoms
Global Items (2)
- Hospital Rating
- Recommend the Hospital
The italicized items will be included in CMS Hospital Compare – October 2026 public reporting.
https://hcahpsonline.org/globalassets/hcahps/quality-assurance/october_2024_final_qag_v19.0.pdf