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

2. 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

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

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

5. 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.

6. 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!

7. 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!

8. 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

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

10. 1/21/08

11. Detox to Continuing Care Study

12. 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

13. 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

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

15. 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