"Every Patient, Every Experience, One Team!" - Improving Transfer of Care from the ED to Inpatient Unit

Purpose:
The Institute of Medicine has reported that the majority of potential medical errors happen when care is transferred from one care provider to another. The goal was to reduce the amount of patient safety reports (variances) by 75% and improve the overall patient experience.

Significance:
A community hospital system was charged with mitigating the risk of medical error during transfer of care from the ED. By engaging the patient/family, the ED RN, the Inpatient RN, and the Physician provider in bedside handoff in the ED, positive patient coutcomes will be achieved.

Strategy and Implementation:
Utilizing LEAN and Six Sigma methodology a multidisciplinary team was set up. The team began by looking at a current state of patient handoff and the many variations of handoff. They developed an "ideal" state. Tools were developed and experiments were carried out. They looked at time stamped,data driven metrics and made all the data provider specific and transparent. The team met weekly for over a year to determine best ways to change a culture, determine what a "patient ready" status was,and what the elements were that would improve the transfer of care process. The ED RN initates the need for an admission and the steps were mapped out that allowed for the Inpatient RN to come to the ED and receive a standardized handoff report at the bedside including the patient/family, the ED RN, and the physican provider. Orders, test & treatments are reviewed in real time and the receiving RN then accompanies the patient up to a higher level of care.

Evaluation:
Success has been measured via the reduction of medical errors/ommissions of care as tracked through the RMPro (variance) reporting system as well as utilizing patient satisfaction data as measured by Press Ganey.

Implications for Practice:
Because report is happening at the bedside, in real-time, including the patient and family, an opportunity to ask questions for all parties exists thus reducing the opportunity for errors or ommissions while improving the overal patient experience and providnig a positive patient outcome.