Focus on Improving Patient Care Through Better Hand-Off Communication
Oct 21, 2010
NewYork-Presbyterian Hospital is one of 10 leading hospitals and health systems in the U.S. to team with the Joint Commission Center for Transforming Healthcare and use new methods to develop ways to improve patient quality and safety. Specifically, the initiative targets hand-off communication failures, which are at the root of an estimated 80 percent of serious medical errors.
Health care organizations have sought to improve the process of passing necessary and critical information about a patient from one caregiver to the next, or from one team of caregivers to another. A hand-off process involves "senders," the caregivers transmitting patient information and releasing the care of the patient to the next clinician, and "receivers," the caregivers who accept the patient information and care of the patient.
Recognizing that this is a critical patient safety issue, the Center for Transforming Health Care, NewYork-Presbyterian and the other participating hospitals and health systems set out to solve the problems through the application of Robust Process Improvement™ tools. RPI is a fact-based, systematic and data-driven problem-solving methodology that allows project teams to discover specific risk points and contributing factors and then develop and implement solutions targeted to those factors to increase overall patient safety and health care quality.
At NewYork-Presbyterian, the initiative is led by Dr. Eliot Lazar, senior vice president and chief quality and patient safety officer; Dr. Karen A. Scott, vice president of quality and patient safety; and Dr. Audrey Compton, quality and patient safety improvement manager.
"Putting patients first means a promise to deliver the safest, highest-quality care available. NewYork-Presbyterian is proud to be working with The Joint Commission and leading hospitals across the country to improve the way we care for patients," says Dr. Lazar.
The Joint Commission's Hand-off Communications Project began in August 2009. During the measure phase of the project, the participating hospitals found that receivers, on average, were only satisfied 60 percent of the time, and there were substantial opportunities for improved satisfaction.
The targeted hand-off solutions from the Center, which are described using the acronym SHARE, address the specific causes of unsuccessful hand-offs. SHARE refers to:
- Standardize critical content, which includes providing details of the patient's history to the receiver, emphasizing key information about the patient when speaking with the receiver and synthesizing patient information from separate sources before passing it on to the receiver.
- Hardwire within your system, which includes developing standardized forms, tools and methods, such as checklists, identifying new and existing technologies to assist in making the hand-off successful, and stating expectations about how to conduct a successful hand-off.
- Allow opportunity to ask questions, which includes using critical thinking skills when discussing a patient's case as well as sharing and receiving information as an interdisciplinary team (e.g., a pit crew). Receivers should expect to receive all key information about the patient from the sender, receivers should scrutinize and question the data, and the receivers and senders should exchange contact information in the event there are any additional questions.
- Reinforce quality and measurement, which includes demonstrating leadership commitment to successful hand-offs such as holding staff accountable, monitoring compliance with use of standardized forms, and using data to determine a systematic approach for improvement.
- Educate and coach includes organizations teaching staff what constitutes a successful hand-off, standardizing training on how to conduct a hand-off, providing real-time performance feedback to staff, and making successful hand-offs an organizational priority.
In addition to NewYork-Presbyterian, other hospitals participating in the Center's hand-off project are:
- Exempla Lutheran Medical Center, Wheat Ridge, Colorado
- Fairview Health Services, Minneapolis, Minnesota
- Intermountain Healthcare LDS Hospital, Salt Lake City, Utah
- Kaiser Permanente Sunnyside Medical Center, Clackamas, Oregon
- The Johns Hopkins Hospital, Baltimore, Maryland
- Mayo Clinic Saint Marys Hospital, Rochester, Minnesota
- North Shore–LIJ Health System Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York
- Partners HealthCare, Massachusetts General Hospital, Boston, Massachusetts
- Stanford Hospital & Clinics, Palo Alto, California
The targeted solutions developed by these pioneering hospitals will be shared with the more than 18,000 health care organizations accredited by The Joint Commission. For more information about the Joint Commission Center for Transforming Healthcare, visit www.centerfortransforminghealthcare.org.
NewYork-Presbyterian Hospital, based in New York City, is the nation's largest not-for-profit, non-sectarian hospital, with 2,353 beds. The Hospital has more than 1 million inpatient and outpatient visits in a year, including more than 220,000 visits to its emergency departments — more than any other area hospital. NewYork-Presbyterian provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, NewYork-Presbyterian/Morgan Stanley Children's Hospital, NewYork-Presbyterian/The Allen Hospital and NewYork-Presbyterian Hospital/Westchester Division. One of the most comprehensive health care institutions in the world, the Hospital is committed to excellence in patient care, research, education and community service. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S.News & World Report. The Hospital has academic affiliations with two of the nation's leading medical colleges: Weill Cornell Medical College and Columbia University College of Physicians and Surgeons.
The Joint Commission Center for Transforming Healthcare
Established in 2009, the Joint Commission Center for Transforming Healthcare aims to transform American health care into a high-reliability industry that ensures patients receive the safest, highest-quality care they expect and deserve. The Center's participants — the nation's leading hospitals and health systems — use a proven, systematic approach to analyze specific breakdowns in care and discover their underlying causes to develop targeted solutions for health care's most critical safety and quality problems. The Center is a not-for-profit affiliate of The Joint Commission, which shares the Center's proven effective solutions with its more than 18,000 accredited health care organizations. Learn more about the Center at www.centerfortransforminghealthcare.org.