Transcript Blend Levels of Care

OFF
Overview
Jay Ford and Collette Croze
A handoff involves the
transfer of patient
information and primary
responsibility between
providers.
Approaches to Improving
Handoffs
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Joint Commission
Improve communication
Impact discharge process
Toyota Production System
FEMA
NIATx Model
Questions to Consider
• Where is the failure
– Internal
– External
• What is the opportunity for
improvement?
• How will you measure the impact?
Joint Commission on Handoffs
• Timely, accurate, complete and fully
understood information improves patient
safety.
JCACHO Strategies for Handoffs
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Provide handoff in the same order every time;
Use verbal, face-to-face communication;
Allow two-way exchange;
Limit distractions;
Allow others to overhear the information;
Complete patient assessment prior to handoff;
Include the "5 Ps"*--patient name, problem list,
plan of care, purpose of plan, precautions.
Strategies to Improve Handoff
Communication
• Use clear language
• Incorporate effective communication
techniques
• Standardize
• Create a smooth hand-off between settings
• Use technology to your advantage
http://ps.mcicvermont.com/appdocs/lps/Strategies%20to%20Improve%20Handoff%20Communication.pdf
What is the communication
barrier?
• Is the message garbled?
• Are we exchanging the right information
or is it a game of “telephone”?
• What type of information is imperative to
share vs. nice to know vs. TMI (too much
information)?
• What is the most effective way to share
information?
IMPROVING HANDOFFS
• Use ‘TEACH BACK’ to assess client’s understanding of
discharge instructions and self care
• Include family and community caregivers as full partners
in assessments and predicting community needs
• Coach clients on:
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Medication self-management
Use of a client-friendly patient-centered record
Importance of follow up with physicians and clinicians
Knowledge of red flags (signs that the client’s condition is
worsening and what to do)
Coaching can reduce readmissions by 50%
Unit Handoff Tool
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Situation
Background
Assessment
Recommendations
DISCHARGE PLANNING
• Community Support Worker participates in discharge
planning
• Community staff meet with client 48 hours before
discharge ( ALL SYSTEMS ‘GO’)
• Specifically identify readmission risk and factors those
into discharge plan
• Provide customized, real time critical info to the next
care provider (THE RIGHT PERSON, THE RIGHT
INFORMATION, REAL TIME)
San Francisco Hospital Example
• Aim: Improve patient transfers to OP medication
management clinics
• Tool: Toyota Production System
• Goals: Improve time of transfer & reduce
communication errors
• What: Sources of error and delay were identified, and a
new process was designed
• Results:
– Time to process transfer and schedule appointment down 87%
– Time to actual appointment down 31%
– # of failed handoff down 89%
San Francisco Hospital Example
• Key principles included:
– Specifying the process in detail –the
content, sequence, timing and responsible
person for each step
– Establishing connections between each
step
– Designing a pathway that is simple
– Continuously assessing the outcome and
striving to improve
San Francisco Hospital Example
• Results:
– Time to process transfer and schedule
appointment down 87%
– Time to actual appointment down 31%
– # of handoffs per month successfully
processed and scheduled up 95%
– # of failed handoff down 89%
• Have been sustained for 3 years
Failure, Mode and Effectiveness
Analysis (FEMA)
• Assess high risk areas
• Analyze processes associated with
those areas
• Look for potential areas for failure
• Seek improvements to reduce failure
likelihood
Strategies to Ease Client Transitions
Between Levels of Care
• Make connections with the next level of care or post-treatment supports: Emphasize the
"we" in each person's journey to long-term recovery. Let them know that there are individuals and
organizations that can help them to sustain their recovery, and wherever possible, establish
personal connections for internal and external referrals. Establish clear two-way expectations and
communication between levels of care.
• The guided tour. Encourage and empower clients to meet with individuals and organizations
providing ongoing recovery supports before they leave the facility through participation in the next
level of care or recovery support groups prior to discharge.
• Streamline Paperwork Streamline the paperwork process between the referral source and
outpatient program to eliminate duplication of effort.
• Reward Attendance at the First Outpatient Appointment Give clients a reward when they
attend the first outpatient session with a clinician and let them know ahead of time about the
reward.
• Overlap Levels of Care Overlap outpatient treatment with treatment from the referring level of
care so that clients have the opportunity to experience outpatient care before being discharged
from the referring level of care.
• Blend Levels of Care Blend other levels of care with outpatient treatment so that clients can
develop therapeutic relationships and familiarity with outpatient clients, therapists, and locations
before moving to outpatient care.
• Orient Clients to Outpatient Treatment Provide orientation for outpatient treatment before
admission and prior to discharge from a referring level of care
Manatee Glens-Sarasota
Detox to outpatient
• Baseline: 66% No show
Baseline
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No show s
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• Change 1
– OP staff meet pts in detox
– No significant effect
• Change 2
– Recovering coaches explain
program/invite
– No shows 37%
• Change 3
– Recovery coaches + calls to
remind 1 day prior
– No shows 30%
• Change 4
– Coaches+calls+detox come
as a group when appropriate
– No shows 26%
Georgetown SC - Ruthena Parker
Inpatient to Outpatient
• Baseline: 51% No Shows
• Change Bundle
No shows
60
50
– Outpatient case worker talk
to patient + inpatient staff
– Schedule appointment
– Identify/remove barriers
– AM reminder call
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0
Baseline
Current
• Current: 25% no shows
NIATx Promising Practices
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Offer a Tour Guide
Overlap Levels of Care
Blend Levels of Care
Include Family and Friends in Discharge and Admission
Planning
Use Motivational Interviewing
Use Video Conferencing
Map Out Continuing Treatment
Orient Clients to Outpatient Treatment
Offer Telephone Support
Reward Attendance at the First Outpatient Appointment