SLOWING THE REVOLVING DOOR EVIDENCE BASED RESEARCH/BEST PRACTICE COMMITTEE SEPTEMBER 19, 2012 Meeting on September 19 to brainstorm

In GOD we trust; all others must use DATA 20% of all Medicare patients readmitted to hospitals within 30 days 33% are readmitted within 90 days Medicare cost of $12 billion to $17 billion annually Average hospital costs Medicare about #9,600 Hospitals failing to meet established (?) readmission goals for HF or pneumonia will lose 1% of their total Medicare payments (Goals have yet to be determined) Data regarding readmissions – this was taken from the Crane’s Detroit article

Goal of CTIC of SEM)* Reduce hospital readmissions by 20% over the next two years which could improve the quality of care and save the Medicare program up to $15 million! EB Research/Best Practice Identify potential interventions currently being used as key drivers (BOOST, STAAR, Bridge Model, INTERACT II, ENA Safer Hand-off, Care Transitions Intervention etc.) *CTIC – Care Transitions Improvement Coalition of Southeastern Michigan CTIC Goals – EB Practice Research reviewed multiple best practice sites for information. Strong support for communication

Room for improvement July 2006 and july 2009 Reamission rates – hospitals that are in the Coalition – similar SEM Hospitals with readmission rates for at least three categories between July 2006 and July 2009. Data completed by Farmington Hills based MPRO. Information published in Crain’s Detroit Business on August 12, 2012

JOINT COMMISSION SENTINEL EVENT DATA DON’T MESS UP THE HAND-OFF!!! Estimated 80% of serious medical errors involve miscommunication during hand-off Majority of avoidable adverse events are due to lack of effective communication One U.S. malpractice insurance agency’s single most common root cause factor leading to claims resulting from patient transfer Solet, DJ et al Lost in translation: challenges-to-physician communication during patient hand-offs. Academic Medicine 2005;80:1094-9 The Joint Commission Sentinel Event Data Unit Andrews C, Miller S. Don’t fumble the handoff. MAG Mutual Healthcare Risk Manager, 2005, 11(28):1-2 http://www.magmutual.com/mmic/article/2005_11_28.pdf One insurance agency showed the common root cause factor was breakdown in communication during transition

IMPROVE TRANSFER OF INFORMATION BIDIRECTIONAL WISH LIST PRIORITIZATION CTIC SURVEY RESULTS (July 18, 2012) Top 5 Current Medication List including time of last dose given (includes Herbal, over the counter, topical, vitamins etc.) Allergies listed (Medication, Food, Environmental) Current Health status Respiratory needs including settings, prescription, DME Face sheet that includes patient name, current & primary address, phone number, insurance information EB Research & Best Practice Committee recommendation: THE TARGET INTERVENTION WILL FOCUS ON COMMUNICATION SOLUTIONS (Substandard transfer of information “hand-off” can result in delay in treatment, adverse events, omissions of care, increased LOS, avoidable readmissions, increased costs, inefficiency from rework, patient , family, caregiver, health care professional dissatisfaction, and most importantly patient harm!!!) Consensus among EB group – need to have communication

SOLUTION: TRANSFER CHECKLISTS & SBAR STANDARIZED CHECKLIST/FORM/METHOD every time a hand-off occurs to cue sender what is needed Send documents in envelope, folder etc. SBAR tool (Situation, Background, Assessment, Referral/Recommendation) communication Sender is responsible for sending data and releasing care of the patient to the receiver, who receives data and accepts care of the patient – be sure to include the caregiver!!! Brainstorming – also need to include caregiver in all of this -

St mary mercy sample transfer checklist for facilities to the ed SMMH created this document with STARForUM members to help with communication. This helps the sender know what the ED needs for a smooth transition SAMPLE Facility checklist to use when transferring resident to the SMMH Emergency Department

Starforum q & a sheet Q & A regarding the transfer sheet so the sender from the facilities understands why the information is important THE “WHY” the information is important! What Health Care Provider wouldn’t want to protect their patient during care transitions?

HOME INSTEAD TRANSFER FORM Sample – still being tweaked SAMPLE TRANSFER FORM CHECKLISTFROM HOME INSTEAD (Coalition and STARForUM member)

EMERGENCY NURSES ASSOICATION SAFER HANDOFF TRANSFER FORM Developed by ENA EMERGENCY NURSES ASSOCIATION (ENA) SAFER HANDOFF TRANSFER FORM

ST MARY MERCY ENVELOPE SAMPLE TRANSFER ENVELOPE FOR SENDING DOCUMENTS Example of an envelope developed at SMMH ER – inpatient units have an envelope too; Many other senior facilities are now using envelopes such as Marywood, Hope, Home Instead non licensed care givers. A color coded system is also being used – red (skilled) yellow assisted (green) (independent) SAMPLE TRANSFER ENVELOPE FOR SENDING DOCUMENTS

HOW TO IMPLEMENT A SUCCESSFUL HAND-OFF HAND-OFF COMMUNICATIONS PROJECT www.centerfortransforminghealthcare.org “SHARE” pneumonic to help with implementation S-- Standardize critical content H--Hardwire within your system A- Allow opportunities to ask questions R – Reinforce quality and measurement E – Educate and coach Checklist + SBAR +Why this is important (Coaching and Educating)+ Accountability (process flow mapping) + Measurement (evaluation) =successful transfer of patients

INTERACT II SBAR COMMUNICATION SAMPLE PROGRESS NOTE FROM INTERACT II USING SBAR

RECOMMENDATION TRANSFER CHECKLIST THAT CONTAINS THE NECESSARY INFORMATION NEEDED FOR SUCCESSFUL DISPOSITION USE COMMON LANGUAGE SUCH AS SBAR WITH EACH COMMUNICATION BETWEEN SENDER AND RECEIVER BE SURE THE RECEIVER HAS TIME TO ASK QUESTIONS AND INCLUDE A CALL BACK NUMBER http://www.hhnmag.com/hhnmag/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/05MAY2008/0805HHN_FEA_Gatefold&domain=HHNMAG