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

2. 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

3. 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

4. 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 Data completed by Farmington Hills based MPRO. Information published in Crain’s Detroit Business on August 12, 2012

5. 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
One insurance agency showed the common root cause factor was breakdown in communication during transition

6. 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

7. 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 -

8. 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

9. 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?

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

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

12. 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

13. HOW TO IMPLEMENT A SUCCESSFUL HAND-OFF
HAND-OFF COMMUNICATIONS PROJECT
“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

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

15. 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