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Safer Sign Out Physician Handoff Communication Achieving to High Reliability Through Patient-Centered, Team-Based Innovation v5.

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Presentation on theme: "Safer Sign Out Physician Handoff Communication Achieving to High Reliability Through Patient-Centered, Team-Based Innovation v5."— Presentation transcript:

1 Safer Sign Out Physician Handoff Communication Achieving to High Reliability Through Patient-Centered, Team-Based Innovation v5

2 Drew C. Fuller, MD, MPH, FACEP Director of Safety Innovation Past Chair, Quality Improvement & Patient Safety Section (QIPS) Board of Directors / Education Committee (Synergy Interest)

3 Safer Sign Out Patient Centered Team Based Risk-Focused Physician (Frontline) Developed Method for Structured Physician Handoffs

4 Standardization of Handoff Communication National Patient Safety Goal 2E (2006)

5 “Sign out is the most dangerous procedure in the Emergency Department” Charles “Chaz” Schoenfeld, MD (1950-2010)

6 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)

7 Progress Nursing profession – Leading with Models/Methods Few Physician Models

8 Emergency Departments - High Risk 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 ED Factors – Potentiate Errors

9 Neglected/Missed Information Unclear Transfer of Responsibility Team Unaware of Transfer/Issues Patient/Family Unaware Change in Status Lack of Mechanism for QA Handoffs - High Risk Points of Potential Failure

10 High Reliability High Risk Process + High Risk Environment Why Structure is Critical Mandates

11 Structured Workable Predictable Measurable High Reliability

12 Industries Committing to High Reliability

13 Pilots Committed to Standardized Communication

14 “Quick” Handoff Practice (Click on Photo to Start Video)

15 Name that Handoff Hit & Run?

16 “Typical” Handoff Practice (Click on Picture to Start Video)

17 “Hopeful Handoff” Name that Handoff

18 What’s Missing? Critical items conveyed? Safeguards? (Checklist?) Current clinical status? Patient aware/Involved? Nurse aware/involved? QA ? Typical ‘Hopeful’ Handoff

19 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

20 Designing a Better Way Focus on areas of RISK Practical implementation Scalable WORK for Clinicians

21 EMA Safety Leadership Group Physician Representation 12 Hospital/Clinical Sites: Maryland Virginia Washington, DC West Virginia

22 American College of Emergency Physicians (ACEP) White Paper on Improving Handoffs by Dickson Cheung, Jack Kelly et al 20 National Clinical & Safety Experts Recommendations for Best Practice Quality Improvement & Patient Safety (QIPS)

23 Sign Out Safety Survey 104 ED Physicians & 50 PAs Directors’ Guidance ACEP QIPS leaders Executive Input Nursing Input & Feedback Frontline Input

24 “The Essential Connections” Physician to Physician Nurse (Team) Patient/Family

25 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

26 Use a Recordable Form Clear transfer of responsibility Prompts to identify Key items Checklist & Reference Tool


28 Back of Sign Out Form (Reinforces Protocol)

29 Joint Focus - Form & Data Done at a computer Access to lab/rad results Assure Shared Understanding Purposeful time for Q & A

30 Bedside Round - Together Status -“Eyes on the patient” Introduction/Update Team Communication

31 Communicate with the Nurse – Transition/Updates Opportunity for input/feedback Assures team understanding Before, during or after rounds

32 Form as a Feedback Tool Clinical Follow Up Quality Assurance Tool

33 Quality Assurance ✔ ✔ Built-in tool to help with QA

34 Initial Hospital Sites

35 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

36 Rapid Cycle Improvement

37 What We Learned Physician Champions (Key) Ease of implementation Educate & support Initial resistance resolves Use QA to sustain

38 Engaging Physicians Appeal to their interest Performance => how it ’Occurs’ to them Listen, support & reassure “Protect Your Patients, Support Your Colleagues”

39 Understanding Adoption

40 Readiness for Change “Start Where They Are”

41 “ 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” Physician Feedback

42 Committed to Collaboration Share the Process Teach Others Seek Understanding Pursue Refinement Regionally/Nationally

43 Quality Improvement & Patient Safety Section Website First Featured Safety Project

44 Emergency Medicine Patient Safety Foundation (EMPSF) Voice for Safety in Emergency Medicine National Collaborator SSO Flagship Safety Tool Dedicated SSO Website Consultation Service

45 Toolkit (Web-based) Education Downloads Forms Posters Strategy/Best Practices Videos & More

46 Logo

47 AMA Handoff Resource Listing Handoff Resource (RFS) Description and links to

48 AMA Handoff Resource Listing Handoff Resource (RFS) Description and links to

49 Agency for Healthcare Research & Quality (List as a Resource)

50 SSO in the Press



53 ABEM MOC PI Tool Help your physicians meet their MOC PI requirement Easily Utilized To be featured on ACEP’s Handoff education tool

54 Collaborative Synergistic Innovation (CSI) Model for Innovation Open Resource Clinician Driven Best Practice Refinement Supports Research, Distribution, Education

55 Innovation Partners Leading the Way

56 1.Use EMPSF as a resource 2.Enlist “Champions” 3.Build the case for a structured method 4.Launch as a Team based approach 5.Monitor the process & give feedback

57 "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.” Atul Gawande

58 Make the Commitment 1963 Speech at NASA Throw Your Hat Over the Wall

59 SSO “Stand Up for Safety” Video

60 We Stand Committed to Safety

61 Further Information Dianne Vass Executive Director Emergency Medicine Patient Safety Foundation (EMPSF) Folsom, California Drew Fuller, MD, MPH, FACEP Director of Patient Innovation Emergency Medicine Associates, PA, PC Germantown, Maryland

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