Transcript CAR Study Intervention

CAR Study Intervention
COMMUNICATING ABOUT READINESS
FOR HOSPITAL DISCHARGE:
AN INTER-PROFESSIONAL INTERVENTION
What is CAR Study?

Communication About Readiness (for discharge)

Approved by the IRB and Nursing Research Council

Goals


Improve the discharge experience of patients through improved
discharge preparation communication between patients and care
team members
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Reduce readmissions and ED visits post-discharge.

Reduce unpaid costs for readmissions
4 phase pre-post intervention cohort study
The evidence for improving health team
communication and collaboration

2010 - 2013: Ineffective communication among
top 3 root causes of sentinel adverse events
(TJC Sentinel Event Data (Root Causes by Event Type)

Poor communication and collaboration 
Patients: Adverse events e.g. medical errors,
Patient-reported poor quality care,
Preventable mortality
Professional Staff: Dissatisfaction and turnover
Baggs, 1999, Martin et al., 2010,
Manojlovich et al., 2007, 2009;
Rosenstein & O’Daniel, 2006
The evidence for health team
communication about discharge

Patients and family caregivers:

Consistently report they do not get enough
preparation for discharge

1/5 of patients report receiving conflicting
information (Cleary et al., 2003
Nurses report

Frustration with lack of communication about
discharge (Foust, 2007; Nosbusch, 2010)
The evidence for health team
communication about discharge

Poor preparation of patients for hospital discharge is
a major contributor to readmission (Jack et al., 2009;
Mistiaen et al., 2007)
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Enhanced communication about discharge is a core
element of effective multi-component interventions
that have produced reductions in readmission
(Kripalani, et al., 2014)
Baseline data
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Nurses talk to nurses

Doctors talk to doctors
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We don’t talk to each other as much as
needed
Med Student
Staff nurses
10
8
6
4
2
0
Resident MD
Attending/consulting
MD
Case Manager
RN Frequency of Communication
before d/c day
RN Frequency of Communication on
d/c day
NP/PA
Pharmacist
MD Frequency of Communication
before d/c day
MD Frequency of Communication on
d/c day
Baseline data – phase 2



250 Froedtert patients and their discharging RN and MD
completed an 8-item validated screening tool for discharge
readiness
Results:
 On the day of discharge, 17% of patients, 23% of nurses, and
13% of physicians rated patients as low readiness for discharge
( and low readiness is associated with a 6-9 fold increase in
odds of readmission).
 For 25% of patients being discharged, there was disagreement
on discharge readiness between the patient, RN, and MD.
Conclusion:
 Patients, RNs, and MDs are not on the same page about
discharge
 There is work to do to improve communication about
discharge among the triad of patient-RN-MD.
Improvement in Discharge
Communication Needed

Building an inter-professional communication system
is needed to avoid information breakdown in fastpaced contexts.
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Practice based training is required, aimed at
developing a deep appreciation of team member
contributions.
Gilardi et al., 2014
Intervention Planning Team

Kristi Opper, MS, RN, ACNS-BC

Dr. Kiran Turaga

Joe Beiler, MS, RN,ACSN-BC

Dr. Fabian Johnston

Dr. Marianne Weiss, DNSc, RN

Dr. Michael Stadler

Sara Darby, BSN, RN, CMSRN

Dr. Jenna Cusic

David Huebner, BSN,RN

Dr. Gregory Larriex

Andrea Melenchuk, BSN, RN, CMSRN

Kim Spitz, APNP
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Nicole Ladwig, BSN, RN, CMSRN

Courtney Johnson, PA
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Kristi Copeland, BSN,RN,CMSRN

Jessica Schaeffer, ADN, RN

Crystal Pietrowski, BSN, RN
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Karen Wilson, BSN, RN

Sarah Kortsch, BSN, RN
MD Teams with RNs
Rounding Process
 Purpose
 To
include patient and family
at bedside
 To
engage RN during rounds at
least once every 24 hours
MD Team/RN Rounding
Checklist
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Enter Room, introduce selves
Patient Subjective Data
Objective Data
Review of labs/tests
Plan of care for day
Medical Milestones
Teaching Needs
Discharge Destination/Needs
Close the loop for follow-up
Update Board
Bedside Communication Board
Update:
• During MD
Rounds
• During
Bedside Shift
Report
• Anytime
there is a
change in
the plan
Demonstration
This video is a enactment of the Physician
Team Rounding Process. To open, left click
on the link. When the video is over, close the
window and you will return to this slide.

Video demonstration of MD Team - RN patient rounding
Next Steps

Implementation of
 MD
Team – RN rounding
 RN-RN

Bedside shift rounding
Real-time coaching by CAR team
members
RN to RN Bedside Shift Report
Checklist
 Enter Room, introduce selves
 Update from MD rounds
o
o
o
o
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
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Plan of care for day
Medical Milestones
Teaching Needs
Discharge Destination/Needs
Review new orders
Check Pumps, safety checks, etc.
Close the loop for follow-up
Update Board
Demonstration
This video is a enactment of the RN-RN
Bedside Shift Report Process. To open, left
click on the link. When the video is over,
close the window and you will return to this
slide.
 Video Demonstration of RN -RN bedside shift
report
Next Steps

Implementation of
 MD
Team – RN rounding
 RN-RN

Bedside shift rounding
Real-time coaching by CAR
team members
CAR contacts

If you have questions about the new
rounding and bedside shift reports,
please contact the CAR study lead on
your unit:

Kristi Opper, Clinical Nurse Specialist 8NT

Joe Beiler, Clinical Nurse Specialist, 7NT