By standardizing verbal and written transitions processes, UW ensures accurate clinical information is exchanged.
Lack of standardized bidirectional verbal and written transition processes between post-acute care facilities and the emergency departments (ED) can cause delays in treatment, redundancy of testing and potentially poor quality of care. The lack of critical clinical information exchange can also be very time consuming and frustrating for the clinical staff resulting in inefficiency of care processes. Standardized verbal and written processes can ensure that the necessary clinical information is exchanged each and every time a patient transitions between settings.
Location- Madison, WI.
Type- Academic medical center.
Number of Beds- 648 beds.
Setting- Urban; however, patients are referred regionally as well.
Payer Mix- For the 2015 fiscal year (from July 2014 to June 2015), our payer mix was the following: 53 percent commercial/capitate programs, 34 percent Medicare, 10 percent Medicaid and 3 percent other government programs.
Population Served- Urban Madison, WI and patients from surrounding regions.
University Hospital is a regional referral center that is home to a Level One adult and pediatric trauma center, burn center, stroke center, organ transplant programs and the UW Carbone Cancer Center.
What We Tried
Our aim was to develop a protocol and tools to be used for transferring patients to and from post-acute care facilities that will improve communication. Using the FOCUS-PDCA process improvement methodology, we began by organizing a multidisciplinary team. The team was comprised of key stakeholders including skilled nursing facilities, assisted living facilities, emergency medical services transport, emergency department, health information management, pharmacy and transitional care. The team collaborated to clarify the current processes to understand the root causes related to communication failures. The key root causes were narrowed down to 4 improvement opportunities with accompanying change ideas that were implemented.
- Root cause – Lack of standardized transfer tools and information sent by post-acute care facility.
- Change idea – Created and implemented a standardized transfer label and standard blue envelope for transferring paper packets.
- Root cause – Process for handling paper documents in the ED results in lost and/or missing documentation.
- Change idea – Simplified scanning process by having ED coordinators scan and index paper documents from post-acute care facilities in the EMR upon the patient’s arrival to the ED.
- Root cause – Lack of standardized handoff to post-acute care facility from ED.
- Change idea – Created and implemented an ED transition checklist to post-acute care facilities, which outlined written documentation and verbal processes to be followed when the patient transitions back to the post-acute setting.
- Root cause – No specific After Visit Summary (AVS) for SNFs and ALFs.
- Change idea – Create and implement an AVS specific to post-acute care facilities (in progress).
Staff in both the ED and post-acute setting have vocalized a high satisfaction level with these processes and tools. Following the initial pilot group of 7 facilities, 61 percent of facilities were sending their patients with the completed transfer label and blue transfer envelope. Immediate scanning of the document by the ED coordinators has improved to 94 percent. In January 2016 the process was rolled out to 10 additional SNFs and ALFs with the goal for continued roll out to other facilities in the region.
- It is important to have all stakeholders at the table to identify processes that will work in all settings.
- Work group leaders must set a no-fault, safe environment for open dialog to occur.
- Attendees should identify internal change agents who have the authority to make necessary changes.
- Reassurance, encouragement and praise for small steps go a long way to sustaining change.