Safer Sign Out Physician Handoff Communication
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Safer Sign Out Physician Handoff Communication Achieving to High Reliability Through Patient-Centered, Team-Based Innovation v5
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Safer Sign Out Physician Handoff Communication. Achieving to High Reliability Through Patient-Centered, Team-Based Innovation . v5. Drew C. Fuller, MD, MPH, FACEP. Past Chair, Quality Improvement & Patient Safety Section (QIPS). Board of Directors / Education Committee. - PowerPoint PPT Presentation
Transcript of Safer Sign Out Physician Handoff Communication
PowerPoint Presentation
Safer Sign Out Physician Handoff CommunicationAchieving to High Reliability Through Patient-Centered, Team-Based Innovation
v5Drew C. Fuller, MD, MPH, FACEP
Director of Safety Innovation
Past Chair, Quality Improvement & Patient Safety Section (QIPS)
Board of Directors /Education Committee(Synergy Interest)Safer Sign OutPatient CenteredTeam BasedRisk-FocusedPhysician (Frontline) DevelopedMethod for Structured Physician Handoffs
Standardization of Handoff Communication
National Patient Safety Goal2E (2006)
4Sign out is the most dangerous procedure in the Emergency DepartmentCharles Chaz Schoenfeld, MD(1950-2010)
Why Structure?Up to 80% of serious medical errors involve miscommunication during handoffs (TJC)
Up to 24% ED malpractice claims related to handoff (Cheung 2010)
ProgressNursing profession Leading with Models/MethodsFew Physician Models
Emergency Departments - High RiskProduction/Time PressureHigh Noise LevelsHigh Acuity MultitaskingTime Sensitive ConditionsRapid Turnover Frequent InterruptionsNew/Unknown Patients Undifferentiated DiagnosisWide Clinical VariationIncreasing Complexity
ED Factors Potentiate ErrorsMarty -8Neglected/Missed InformationUnclear Transfer of ResponsibilityTeam Unaware of Transfer/IssuesPatient/Family UnawareChange in StatusLack of Mechanism for QAHandoffs - High Risk
Points of Potential FailureWhy Structure is Critical
MandatesStructuredWorkablePredictableMeasurableHigh Reliability
Industries Committing to High Reliability
Pilots Committed to Standardized Communication
Quick Handoff Practice
(Click on Photo to Start Video)
Name that HandoffHit & Run?
Typical Handoff Practice
(Click on Picture to Start Video)
Hopeful HandoffName that Handoff
Whats Missing?
Critical items conveyed?Safeguards? (Checklist?)Current clinical status?Patient aware/Involved?Nurse aware/involved?QA ?
Typical Hopeful Handoff Hope Model for SafetyHope nothing goes wrongSafe By Luck or Design?Unstructured No StandardNot High Reliability (High Vulnerability)Poor Strategy for Safety
Designing a Better WayFocus on areas of RISKPractical implementationScalableWORK for Clinicians
Marty20
EMA Safety Leadership GroupPhysician Representation 12 Hospital/Clinical Sites:Maryland Virginia Washington, DCWest Virginia
marty21American College of Emergency Physicians (ACEP) White Paper on Improving Handoffs by Dickson Cheung, Jack Kelly et al 20 National Clinical & Safety ExpertsRecommendations for Best Practice
Quality Improvement & Patient Safety (QIPS)Sign Out Safety Survey 104 ED Physicians & 50 PAsDirectors GuidanceACEP QIPS leaders Executive InputNursing Input & FeedbackFrontline Input
The Essential Connections
Physician to Physician
Nurse (Team)
Patient/FamilyWhen 2 physicians are handing off the care of a patient it is important to consider The Essential Connection between the patient, nursing team and the transferring physicians/providers.24Key Components Safer Sign Out Record - Critical Data & Pending ItemsReview - Form & Computer Data Round Bedside, TogetherRelay to the Team Nurse Collaboration_____________________________________________________________________________________________________Receive Feedback Clinical/QA
1) Record Use a Recordable Form
Clear transfer of responsibility
Prompts to identify Key items
Checklist & Reference Tool
Back of Sign Out Form (Reinforces Protocol)
2) ReviewJoint Focus - Form & Data
Done at a computer Access to lab/rad results
Assure Shared UnderstandingPurposeful time for Q & A
3) Round - BedsideBedside Round - Together
Status -Eyes on the patient
Introduction/Update
Team Communication
Marty304) Relay to the TeamCommunicate with the Nurse Transition/UpdatesOpportunity for input/feedbackAssures team understandingBefore, during or after rounds
5) Receive FeedbackForm as a Feedback Tool
Clinical Follow UpQuality Assurance Tool
Quality Assurance
Built-in tool to help with QA
Initial Hospital Sites
Marty34Initial SSO Development TeamDon Infeld, MD (EMA President)Jackie Pollock, CEO (EMA)Nicole Bergen, Dir. of Op. (EMA)Martin Brown, MD, CMO (EMA)John Schnabel, MD Chris Morrow, MDTim Hsu, MDRichard Ferraro, MDKarla Lacayo, MDCameron Cushing, MDMichael Kerr, MDSteven Smith, MDDavid Jacobs, MDJennifer Abele, MDDrew White, MD, MBAMichael Silverman, MDMarney Treese, MD
Justin Green, MDNapoleon Magpantay, MDKurt Rodney, MDSora Chung, MDMatt Sasser, MDJon DSouza, MDTodd Larson, MDJunior Williams, MDLarry Mack-Wilson, PA-CEric Parvis, MDChris Morrow, MDKala Scoggin, PA-CElizabeth CookDrew Fuller, MD, MPHKilole Kanno, MDNadia Eltaki,MD
Marty35
Rapid Cycle Improvement
36What We LearnedPhysician Champions (Key)Ease of implementationEducate & supportInitial resistance resolvesUse QA to sustain
Engaging Physicians
Appeal to their interestPerformance => how it Occurs to themListen, support & reassure
Protect Your Patients, Support Your ColleaguesMarty38
Understanding Adoption
Readiness for Change
Start Where They Are This is so much better than what we use to do I was initially resistant but now I get itI sleep better at night Physician Feedback
Marty?41Committed to CollaborationShare the ProcessTeach OthersSeek UnderstandingPursue RefinementRegionally/Nationally
Marty42American College of Emergency Physicians (ACEP)Quality Improvement & Patient Safety Section Website
First Featured Safety Project
Emergency Medicine Patient Safety Foundation (EMPSF)Voice for Safety in Emergency MedicineNational CollaboratorSSO Flagship Safety ToolDedicated SSO WebsiteConsultation Service
SaferSignOut.comToolkit (Web-based)EducationDownloadsFormsPostersStrategy/Best PracticesVideos & More
Logo
AMA Handoff Resource Listing Handoff Resource (RFS)Description and links to SaferSignOut.com
AMA Handoff Resource Listing Handoff Resource (RFS)Description and links to SaferSignOut.com
Agency for Healthcare Research & Quality (List SaferSignOut.com as a Resource)
SSO in the Press
SSO in the Press
Educational/Promotional Poster
ABEM MOC PI ToolHelp your physicians meet their MOC PI requirementEasily Utilized To be featured on ACEPs Handoff education tool
Collaborative Synergistic Innovation (CSI) Model for InnovationOpen ResourceClinician DrivenBest Practice RefinementSupports Research, Distribution, Education
Innovation PartnersLeading the Way
YOU
Getting Started 1,2,3...Use EMPSF as a resourceEnlist Champions Build the case for a structured method Launch as a Team based approach Monitor the process & give feedback
"Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.Atul Gawande
Make the Commitment
1963 Speech at NASA
Throw Your Hat Over the WallSSO Stand Up for Safety Videohttps://vimeo.com/65199210
We Stand Committed to Safety
Further InformationDianne VassExecutive DirectorEmergency Medicine Patient Safety Foundation (EMPSF)Folsom, California
Drew Fuller, MD, MPH, FACEPDirector of Patient InnovationEmergency Medicine Associates, PA, PCGermantown, MarylandEMAOnline.com
