Building Safe transitions

‘The ABC of Handover’: impact on shift handover in the emergency department

Farhan M et al, Agency for Healthcare Quality and Research

Emerg Med J. 2011 Dec 28; [Epub ahead of print]

A structured tool for handoffs improved the quality of shift change handoffs in a British emergency department.

A clinical nurse specialist intervention to facilitate safe transfer from ICU

St-Louis L and Brault D, Agency for Healthcare Research and Quality

Clin Nurse Spec. 2011 Nov-Dec;25(6):321-6

The purpose of this article is to describe an innovative quality initiative implemented by the clinical nurse specialists in medicine to facilitate the transition process between the intensive care unit and the medical wards. A systematic evaluation of patients before their transfer from the ICU to a medical unit, has been proven beneficial in ensuring a comprehensive patient care plan. Patients and families have verbalized that this intervention is helpful. Staff members have indicated that this safety initiative is useful in planning patient transfers.

Conservative Prescribing Needed to Improve Medication Safety

Agency for Healthcare Research and Quality

Acute Care Edition. November 17, 2011;16:1-3

This piece highlights conservative prescribing as a strategy to prevent overuse of medication.

High-Hanging Fruit: Improving Transitions in Health Care

Perry SJ et al, Agency for Healthcare Research and Quality

The article discusses the role of standardization for enhancing the safety of health care transitions. In particular, the focus is on the most frequently occurring transitions—shift change signovers and handoffs—and the importance of structuring flexibility into any improvement efforts for the preservation of existing but latent safety features.

Three interesting Prescriptions for Excellence issues on “Transition of Care” from the Jefferson School of Population Health and Lilly USA. Please visit their site to access additional information and other useful resources – http://www.jefferson.edu/population_health/

• Primary Care: A Key Role in Managing Transitions of Care

  Issue 12, Summer 2011

  The lead article in the issue, “Reducing Hospital Costs by Means of Enhanced Primary Care,” focuses on the Patient-Centered Medical Home (PCMH). The author outlines the rationale and traces the development of this promising model for primary care, and reviews the evidence of hospital cost reductions associated with PCMH demonstration projects throughout the country. The second article, “Reducing Regional Hospital Readmissions: The PAVE Project,” describes a novel initiative designed to reduce regional hospital readmission rates by 10% over an 18-month period by means of improved transitions of care among providers and increased patient and family engagement in care management.

• A Call to Action on Transitions of Care (TOC)

  Issue 11, Spring 2011

  The first article in the issue, “The Role of Readmission Risk Assessment in Reducing Potentially Avoidable Rehospitalizations,” introduces some recently developed generic models that are relatively simple to apply, and promotes the use of a comprehensive readmission reduction system as part of an organization-wide strategy for cost savings. After documenting the facts and discussing the magnitude of the problem, the article entitled “Handoffs and Transitions in Care: An Inpatient Perspective” presents a real-world example of the positive change that can be achieved with a system-wide overhaul of TOC practices. Finally, “Pharmacists: Part of the Transitions of Care Team in the Ambulatory Setting” introduces the relatively new concept of medication therapy management and suggests a broad range of venues and opportunities in which specially trained pharmacists are well suited to the task of improving TOC, particularly for patients with multiple chronic conditions.

• Lost in Transition

  Issue 10, Winter 2010

  The three articles in this issue touch on many different aspects of transitions of care (TOC). The first, “Transition of Care Program Evaluation: Accountability and Attribution,” offers insight into the essential elements of TOC improvement, and provides a five-step process for designing an initiative. The second article, “Reporting Patient Safety Events: Learning Opportunities for Resident Physicians,” approaches the issue from the clinical training perspective. Last article, “Improved Transitions Through Accountable Care Organizations,” provides an excellent overview of this promising new model, using the successful Program of All-inclusive Care for the Elderly (PACE) as an example.

What Will it Take to Ensure High Quality Transitional Care?

Eric Coleman, The Care Transitions Program, 2011

This brief article lists seven strategies for ensuring high quality transitional care.

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