Safer Sign Out Physician Handoff Communication Achieving High
- Slides: 61
Safer Sign Out Physician Handoff Communication Achieving High Reliability Through Patient-Centered, Team-Based Innovation v 5
Drew C. Fuller, MD, MPH, FACEP Board of Directors / Education Committee Past Chair, Quality Improvement & Patient Safety Section (QIPS) (Synergy Interest) Director of Safety Innovation
Safer Sign Out • Patient Centered • Team Based • Risk-Focused • Physician (Frontline) Developed • Method for Structured Physician Handoffs
National Patient Safety Goal 2 E (2006) Standardization of Handoff Communication
“Sign out is the most dangerous procedure in the Emergency Department” Charles “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)
Progress • Nursing profession – Leading with Models/Methods • Few Physician Models
Emergency Departments - High Risk ED Factors – Potentiate Errors • • • Production/Time Pressure High Noise Levels High Acuity Multitasking Time Sensitive Conditions Rapid Turnover Frequent Interruptions New/Unknown Patients Undifferentiated Diagnosis Wide Clinical Variation Increasing Complexity
Handoffs - High Risk Points of Potential Failure • • • Neglected/Missed Information Unclear Transfer of Responsibility Team Unaware of Transfer/Issues Patient/Family Unaware Change in Status Lack of Mechanism for QA
Why Structure is Critical High Risk Process + High Risk Environment Mandates High Reliability
High Reliability • Structured • Workable • Predictable • Measurable
Industries Committing to High Reliability
Pilots Committed to Standardized Communication
“Quick” Handoff Practice (To view the video, click https: //vimeo. com/68618147)
Name that Handoff Hit & Run?
“Typical” Handoff Practice (To view the video, click https: //vimeo. com/68618456)
Name that Handoff “Hopeful Handoff”
What’s Missing? Typical ‘Hopeful’ Handoff • Critical items conveyed? • Safeguards? (Checklist? ) • Current clinical status? • Patient aware/Involved? • Nurse aware/involved? • QA ?
Hope Model for Safety • Hope nothing goes wrong • Safe By Luck or Design? • Unstructured – No Standard • Not High Reliability (High Vulnerability) • Poor Strategy for Safety
Designing a Better Way • Focus on areas of RISK • Practical implementation • Scalable • WORK for Clinicians
EMA Safety Leadership Group Physician Representation 12 Hospital/Clinical Sites: Maryland Virginia Washington, DC West Virginia
American College of Emergency Physicians (ACEP) Quality Improvement & Patient Safety (QIPS) • White Paper on Improving Handoffs by Dickson Cheung, Jack Kelly et al • 20 National Clinical & Safety Experts • Recommendations for Best Practice
Frontline Input • Sign Out Safety Survey • 104 ED Physicians & 50 PAs • Directors’ Guidance • ACEP QIPS leaders • Executive Input • Nursing Input & Feedback
“The Essential Connections” Physician to Physician Patient/Family Nurse (Team)
Key Components Safer Sign Out 1) Record - Critical Data & Pending Items 2) Review - Form & Computer Data 3) Round – Bedside, Together 4) Relay to the Team – Nurse Collaboration ___________________________________________________ 5) 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) Review Joint Focus - Form & Data • Done at a computer Access to lab/rad results • Assure Shared Understanding Purposeful time for Q & A
3) Round - Bedside Round - Together • Status -“Eyes on the patient” • Introduction/Update • Team Communication
4) Relay to the Team Communicate with the Nurse – Transition/Updates • Opportunity for input/feedback • Assures team understanding • Before, during or after rounds
5) Receive Feedback Form as a Feedback Tool • Clinical Follow Up • Quality Assurance Tool
Quality Assurance ✔ ✔ Built-in tool to help with QA
Initial Hospital Sites
Initial SSO Development Team • • • • • Don Infeld, MD (EMA President) Jackie Pollock, CEO (EMA) Nicole Bergen, Dir. of Op. (EMA) Martin Brown, MD, CMO (EMA) John Schnabel, MD Chris Morrow, MD Tim Hsu, MD Richard Ferraro, MD Karla Lacayo, MD Cameron Cushing, MD Michael Kerr, MD Steven Smith, MD David Jacobs, MD Jennifer Abele, MD Drew White, MD, MBA Michael Silverman, MD Marney Treese, MD • • • • Justin Green, MD Napoleon Magpantay, MD Kurt Rodney, MD Sora Chung, MD Matt Sasser, MD Jon D’Souza, MD Todd Larson, MD Junior Williams, MD Larry Mack-Wilson, PA-C Eric Parvis, MD Chris Morrow, MD Kala Scoggin, PA-C Elizabeth Cook Drew Fuller, MD, MPH Kilole Kanno, MD Nadia Eltaki, MD
Rapid Cycle Improvement
What We Learned • Physician Champions (Key) • Ease of implementation • Educate & support • Initial resistance resolves • Use QA to sustain
Engaging Physicians “Protect Your Patients, Support Your Colleagues” • Appeal to their interest • Performance => how it ’Occurs’ to them • Listen, support & reassure
Understanding Adoption
Readiness for Change “Start Where They Are”
Physician Feedback “ This is so much better than what we use to do” “ I was initially resistant but now I get it” “I sleep better at night”
Committed to Collaboration • Share the Process • Teach Others • Seek Understanding • Pursue Refinement • Regionally/Nationally
American 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 Medicine • National Collaborator • SSO Flagship Safety Tool • Dedicated SSO Website • Consultation Service
Safer. Sign. Out. com Toolkit (Web-based) • • • Education Downloads Forms Posters Strategy/Best Practices Videos & More
Logo
AMA Handoff Resource Listing • Handoff Resource (RFS) • Description and links to Safer. Sign. Out. com
AMA Handoff Resource Listing • Handoff Resource (RFS) • Description and links to Safer. Sign. Out. com
Agency for Healthcare Research & Quality (List Safer. Sign. Out. com as a Resource)
SSO in the Press
SSO in the Press
Educational/Promotional Poster
ABEM MOC PI Tool • Help your physicians meet their MOC PI requirement • Easily Utilized • To be featured on ACEP’s Handoff education tool
Collaborative Synergistic Innovation (CSI) • Model for Innovation • Open Resource • Clinician Driven • Best Practice Refinement • Supports Research, Distribution, Education
Innovation Partners Leading the Way YOU
Getting Started 1, 2, 3. . . 1. 2. 3. 4. 5. Use EMPSF as a resource Enlist “Champions” Build the case for a structured method Launch as a Team based approach Monitor the process & give feedback
Atul Gawande "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. ”
Make the Commitment 1963 Speech at NASA Throw Your Hat Over the Wall
SSO “Stand Up for Safety” Video https: //vimeo. com/65199210
We Stand Committed to Safety
Further Information Dianne Vass Drew Fuller, MD, MPH, FACEP Executive Director Emergency Medicine Patient Safety Foundation (EMPSF) Folsom, California Director of Patient Innovation Emergency Medicine Associates, PA, PC Germantown, Maryland EMAOnline. com Dvass@EMPSF. org Drewfuller@mac. com
- Physician sign out
- Safer sign out
- Mesh wifi handoff
- Ipass handoff examples
- Network controlled handoff
- 5 p's of patient handoff
- All traffic signs and meanings
- One direction figurative language
- Achieving success through effective business communication
- Achieving success through effective business communication
- Trossues sign
- Trousseau's
- Hypophosphatemia symptoms
- Kernig sign
- Negative times a positive
- Safer trial
- Safer access framework
- Act 2 scene 3 othello summary
- Engineering a safer world
- Safer recruitment consortium
- Maybo safer model
- Why are expressways safer than other types of roads
- Safersyst
- Single level inheritance is safer than
- Engineering a safer world
- Safer-r model
- To err is human building a safer health system
- Safersys carrier snapshot
- Safer web mc
- Dvsat questions
- Safer care victoria
- Self-driving coalition for safer streets
- Safer places scheme
- Chapter 11 driving on expressways
- A physician claims that joggers maximum volume
- Physician reentry programs
- Physician consortium for performance improvement
- Physician time studies
- Physician segmentation methodology
- Physician competency reference set
- Coalition for physician enhancement
- Jeannie watkins
- Elisha goodman prayer points
- Maryland physician health program
- Physician burnout retreat
- Physician employment models
- Sachin khullar
- Werkplekleren epa zorg
- Family medicine fellowships
- University of new england physician assistant program
- Physician personas
- Uscis surgeon locator
- Dr patient relationship ethics
- Disadvantages of cpoe
- Oklahoma board of nursing
- A physician claims that joggers maximum volume
- Physician recruitment onboarding and retention
- The good physician treats the disease
- Wellstar physicians group
- Stanford physician wellness survey
- Ohio association of physician assistants
- Pa ieb physician certification form