2. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net “Three things can happen, two of them are bad” Woody Hayes It is the System, not the Patient..... Really!!!

3. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Handoffs A universal challenge 25% of all ATC errors w/in 15 min of handoff Piper alpha oil platform explosion –167 dead –Handoff Willy King - Wrong leg noted for amputation –Handoff

4. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Unaccompanied minors Relay races 911 Football NASCAR pit stops Surgery to ICU Curative care to hospice

5. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Successful handoffs 10-25% connected 30% connected 52% planned discharge

6. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Language is key. –Have 25 seconds to give as much info as possible. –Need standard language: Explode, Zoom, I Right, Silver, Snap (back) (tight end) (receiver) (lineman) (QB) blah, blah, blah, Silver, blah. –Precise job for each player. –Each player has only a few things to do, but combinations are endless. –Practice, Practice, Practice.

7. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net The Big Thing! If the handoff fails, it is the system’s fault. It is never the patient’s fault! If the right process was in place the patient would have continued to the next level of care!

8. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net A great handoff system Commitment (Take Handoffs Seriously) Giver & Receiver must be a team. Giver owns patient till Receiver signals “done”. Handoff process & preparation are:  Standardized & Scripted  Synchronized  Practiced, Practiced, Practiced Processes & outcomes are measured & fed back.  Qualitative & quantitative evaluation of preparation & transfer

9. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Sentara Health: Surgery to SICU –Worked for years to get smooth transfer –Surgery televises status to SICU When surgery started, etc. –SICU knows what lines to prepare for patient –1 hr. prior, scripted process to relay info –Anesthesiologist & patient go together –Scripted information to intensivist and nurse –Stay till lines hooked & Tx info read out loud.

10. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Common strategies Everyone knows who is responsible for what Receiver studies patient info & current status first No interruption during handoff Face to face. Consistent order of information presentation Clear signal that handoff has occurred

11. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net Manatee Glens - Bradenton Detox to outpatient Baseline: 66% No show Change 1 –OP staff meet pts in detox –No significant effect Change 2 –Recovering coaches explain program/invite –No shows 37% Change 3 –Recovery coaches + calls to remind 1 day prior –No shows 30% Change 4 –Coaches+calls+detox come as a group when appropriate –No shows 26% Linda Transue & Karen Berner

12. Reduce Waiting & No-Shows  Increase Admissions & Continuation www.NIATx.net We can do this! Mission Passion and commitment A lifestyle; not a job Tools & knowledge to make it achievable