Overview Hand-offs & Transitions For the DHA/NIATx Wisconsin Mental Health Readmissions Collaborative April 19, 2017 1

Handoffs A universal challenge 25% of all ATC errors w/in 15 min of handoff Piper alpha oil platform explosion 167 dead Handoff Wrong leg noted for amputation

And many more. Relay races 911 Football NASCAR pit stops Surgery to ICU Curative care to hospice Detox to residential

Successful handoffs We have problems too! 10-25% connected 30% 52% planned discharge Successful handoffs

Language is key. Have 25 seconds to give as much info as possible. Need standard language: Explode, Zoom, I Right, Silver, Snap (back) (tight end) (receiver) (lineman) (QB) blah, blah, blah, Silver, blah. No question. Precise job for each player. Each player has only a few things to do, but the combinations are endless. Repetition, Practice, Practice, Practice.

The Big Thing! It is never the patient’s fault! If the handoff fails, it is the system’s fault. It is never the patient’s fault! If the right process was in place the patient would have continued to the next level of care!

A great handoff system Nothing left to chance! Commitment (Take Handoffs Seriously) Giver & Receiver must be a team. Giver owns patient till Receiver signals “done”. Handoff process & preparation are: Standardized & Scripted Synchronized Practiced, Practiced, Practiced Processes & outcomes are measured & fed back. Qualitative & quantitative evaluation of preparation & transfer Nothing left to chance!

Video Introduction to Next Level of Care Video created to demystify first visit to outpatient offices Video re-shot to better capture desired messages Video given to Hospital for units Case Managers with portable DVD player 1/21/08

B.-S.T.A.R. Transition Worksheet

1/21/08

Detox to Continuing Care Study

Logistic Regression No Items: OR = .014 Warm Hand-offs: OR = 4.94 CC Informed of Referral: OR = 12.26 Detox unit Doc Attend.: OR = 3.18

Common strategies Everyone knows who is responsible for what Receiver studies patient info & current status first No interruption during handoff Face to face. Consistent order of information presentation Clear signal that handoff has occurred Reduce wait times

Post-Discharge Post-discharge follow-up (phone, case mgt.,) A walk-through / flowcharting opportunity

We can do this! Mission Passion and commitment A lifestyle; not a job Strong sense of community Optimism: recovery is achievable Tools & knowledge to make it achievable