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CAR Study Intervention COMMUNICATING ABOUT READINESS FOR HOSPITAL DISCHARGE: AN INTER-PROFESSIONAL INTERVENTION.

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Presentation on theme: "CAR Study Intervention COMMUNICATING ABOUT READINESS FOR HOSPITAL DISCHARGE: AN INTER-PROFESSIONAL INTERVENTION."— Presentation transcript:

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2 CAR Study Intervention COMMUNICATING ABOUT READINESS FOR HOSPITAL DISCHARGE: AN INTER-PROFESSIONAL INTERVENTION

3 What is CAR Study?  Communication About Readiness (for discharge)  Approved by the IRB and Nursing Research Council  Goals  Improve the discharge experience of patients through improved discharge preparation communication between patients and care team members  Reduce readmissions and ED visits post-discharge.  Reduce unpaid costs for readmissions  4 phase pre-post intervention cohort study

4 The evidence for improving health team communication and collaboration  : Ineffective communication among top 3 root causes of sentinel adverse events (TJC Sentinel Event Data (Root Causes by Event Type)  Poor communication and collaboration  Patients: Adverse events e.g. medical errors, Patient-reported poor quality care, Preventable mortality Professional Staff: Dissatisfaction and turnover Baggs, 1999, Martin et al., 2010, Manojlovich et al., 2007, 2009; Rosenstein & O’Daniel, 2006

5 The evidence for health team communication about discharge  Patients and family caregivers:  Consistently report they do not get enough preparation for discharge  1/5 of patients report receiving conflicting information (Cleary et al., 2003 Nurses report  Frustration with lack of communication about discharge (Foust, 2007; Nosbusch, 2010)

6 The evidence for health team communication about discharge  Poor preparation of patients for hospital discharge is a major contributor to readmission (Jack et al., 2009; Mistiaen et al., 2007)  Enhanced communication about discharge is a core element of effective multi-component interventions that have produced reductions in readmission (Kripalani, et al., 2014)

7 Baseline data  Nurses talk to nurses  Doctors talk to doctors  We don’t talk to each other as much as needed

8 Baseline data – phase 2  250 Froedtert patients and their discharging RN and MD completed an 8-item validated screening tool for discharge readiness  Results:  On the day of discharge, 17% of patients, 23% of nurses, and 13% of physicians rated patients as low readiness for discharge ( and low readiness is associated with a 6-9 fold increase in odds of readmission).  For 25% of patients being discharged, there was disagreement on discharge readiness between the patient, RN, and MD.  Conclusion:  Patients, RNs, and MDs are not on the same page about discharge  There is work to do to improve communication about discharge among the triad of patient-RN-MD.

9 Improvement in Discharge Communication Needed  Building an inter-professional communication system is needed to avoid information breakdown in fast- paced contexts.  Practice based training is required, aimed at developing a deep appreciation of team member contributions. Gilardi et al., 2014

10 Intervention Planning Team  Kristi Opper, MS, RN, ACNS-BC  Joe Beiler, MS, RN,ACSN-BC  Dr. Marianne Weiss, DNSc, RN  Sara Darby, BSN, RN, CMSRN  David Huebner, BSN,RN  Andrea Melenchuk, BSN, RN, CMSRN  Nicole Ladwig, BSN, RN, CMSRN  Kristi Copeland, BSN,RN,CMSRN  Jessica Schaeffer, ADN, RN  Crystal Pietrowski, BSN, RN  Karen Wilson, BSN, RN  Sarah Kortsch, BSN, RN  Dr. Kiran Turaga  Dr. Fabian Johnston  Dr. Michael Stadler  Dr. Jenna Cusic  Dr. Gregory Larriex  Kim Spitz, APNP  Courtney Johnson, PA

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12 MD Teams with RNs Rounding Process  Purpose  To include patient and family at bedside  To engage RN during rounds at least once every 24 hours

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14 MD Team/RN Rounding Checklist

15 Bedside Communication Board Update: During MD Rounds During Bedside Shift Report Anytime there is a change in the plan

16 Demonstration  Video demonstration of MD Team - RN - patient rounding Video demonstration of MD Team - RN - patient rounding This video is a enactment of the Physician Team Rounding Process. To open, left click on the link. When the video is over, close the window and you will return to this slide.

17 Next Steps  Implementation of  MD Team – RN rounding  RN-RN Bedside shift rounding  Real-time coaching by CAR team members

18 RN to RN Bedside Shift Report Checklist

19 Demonstration  Video Demonstration of RN -RN bedside shift report Video Demonstration of RN -RN bedside shift report This video is a enactment of the RN-RN Bedside Shift Report Process. To open, left click on the link. When the video is over, close the window and you will return to this slide.

20 Next Steps  Implementation of  MD Team – RN rounding  RN-RN Bedside shift rounding  Real-time coaching by CAR team members

21 CAR contacts  If you have questions about the new rounding and bedside shift reports, please contact the CAR study lead on your unit:  Kristi Opper, Clinical Nurse Specialist 8NT  Joe Beiler, Clinical Nurse Specialist, 7NT


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