Safer transitions of care at a major cancer center: The emergency center to hospitalist experience.
J Clin Oncol. 2016 Mar;34(7_suppl):247
Authors: Gonzalez CE, Brito-Dellan N, Rubio D, Ait Aiss M, Rice T, Chen K, Bodurka DC, Escalante CP
247 Background: Failures in communication lead to serious medical errors particularly during transitions of care. A standardized handoff of patients requiring admission to the inpatient setting between the Emergency Center (EC) and the Hospitalist Inpatient Service (HIS) at a comprehensive cancer center was lacking during this vulnerable time.
METHODS: A quality pilot study using Plan, Do, Study, Act methodology was conducted. First, root cause analysis and process mapping of the current state was performed to identify pitfalls of the handoff process between the EC and the Hospitalist Service. Second, a validated standardized handoff tool, "I-PASS" (Illness severity, Patient summary, Action list, Situational awareness and contingency planning, and Synthesis by receiver) was selected and then transformed to DE-PASS, where D stands for Decisive problem requiring admission and E for Evaluation, to suit the EC workflow. The DE-PASS identified patients at higher risk for complications as urgent and emergent in the evaluation section and required a verbal communication in addition to an email using DE-PASS format. Third, we measured pre versus post intervention impact metrics. ICU transfers and Rescue Team calls within 24 hours were obtained from 822 patients. Time interval between EC admission physician order and HIS order was analyzed in a population of 174 randomly selected patients. Provider satisfaction with handoffs was surveyed.
RESULTS: The DE-PASS utilization ranged from 75% to 100% by the end of the pilot. The data analysis revealed a 60% reduction in the number of ICU transfers and a 64% reduction of Rescue Team calls post intervention. There was an 18% reduction in the interval time for an inpatient order in the medical record. EC Physicians satisfaction with DE-PASS increased by 10% and the Hospitalists increased by 40%.
CONCLUSIONS: Implementation of the standardized handoff tool DE-PASS led to improved communication between two clinical services of a major cancer center. Patients' safety improved by designation of risk stratification and reducing the time to evaluate unstable patients by the receiving HIS. Physician's satisfaction with the handoff process increased.
PMID: 28152929 [PubMed - in process]