Safe and Effective Patient Care Transitions Are Our Priority
Effective patient-care transitions and care coordination are both challenging and critical to providing quality patient care. Partners HealthCare has been working successfully to improve systems locally and at the national level since 2001.
Why is this work important? We do not have to look far for examples of individual patients who were affected by a poorly managed transition or “hand-off.” One such patient was previously on Warfarin (a blood thinner) at home prior to major heart surgery. She was put on Heparin (another blood thinner) while in the hospital to prevent a blood clot and possible stroke. At discharge, her Warfarin was not restarted, her Heparin was not continued and there was no mention of either medication in the discharge summary from the surgical service. The efforts to clarify why the patient was no longer on anticoagulation took several hours of clinician time at her rehabilitation facility. Fortunately, she did not have a stroke because an alert clinician caught the error and moved quickly to rectify it.
These problems occur because for each patient there can be multiple hand-offs between providers (a change of shift by nurses and doctors), multiple providers involved in care (cardiologist, orthopedist, rehab doctor and primary care doctor all caring for the same patient), and multiple locations of care (a hospital, rehabilitation facility, outpatient clinic). Throughout Partners HealthCare, we are working on systems that will ensure these transitions between providers and locations occur smoothly in order to prevent issues like this patient experienced.
We have focused on efforts to advocate and ensure that essential critical elements like Warfarin medication are accurately documented in the discharge process; now when a patient is discharged, the next provider can make an informed decision on the patient’s care. For example, Brigham and Women’s Hospital improved their electronic discharge processes and now automatically imports critical medication information into the discharge summary 100 percent of the time, hence making this information reliably available to the next level of care. At our community hospital, North Shore Medical Center, the case-management team manually checks to make sure that critical clinical information for every patient being discharged to a sub-acute facility is included before the patient is released. We are working to ensure that discharge information is always available in a timely manner. These efforts not only ensure safe patient care but are likely to reduce preventable readmissions. Using solutions targeted to the specific causes of an inadequate hand-off, such as standardizing the method and type of communications between caregivers, helped participating organizations achieve an average reduction of 52 percent in defective hand-offs.
Another way we are improving transitions across all Partners HealthCare hospitals is to educate incoming residents through a web-based tutorial on how to create high-quality discharge summaries, which provide detailed information about the patient’s hospitalization to the next provider of care. Residents learn the fundamentals behind a discharge summary, what to avoid and how to make certain that essential critical elements, like Warfarin medication, are accurately documented in the discharge process.
We also participated in a yearlong collaborative project to improve hand-off communication with the Joint Commission Center for Transforming Healthcare, and we were the only Massachusetts health care organization to be included in this initiative. At the state level, Partners clinicians have worked with the Massachusetts Health Data Consortium, which developed a statewide strategic plan for improving transitions.
The clinicians and leadership in the Partners HealthCare system recognized early in this decade that quality care is not just about the care in one institution – it’s what happens between institutions. And if we don’t pay close attention to those gaps – which means measuring and acting to improve the information flow – the patient will suffer. We are very pleased about the progress that we have made, and we are honored to be part of this work at the state and national level with the Joint Commission. We all realize that much remains to be done to ensure patient care, but our commitment is strong and unwavering.
Tags: coordinated care, patient safety, uniform high quality
