Imagine that. Ingenious.

Using Ingenious Med’s CrossCover Function to Save Lives and Save

Time Glenn D. Focht. M.D.

Patient Safety and Operations Consultant, IMimgldafo@gmail.com

Agenda

I. Why are effective patient handoffs so important?

II. What barriers exist to safe handoffs in your program or practice?

III. Can IM CrossCover be your time-saving solution?

IV. Questions, next steps.

Why Are Effective Handoffs so Important?

Webinar Live Vote Question:– In the last 30 days, have you been

aware of an episode of patient harm that was the result of a quality sign-out, a poor sign-out, or an absent sign-out?

Why Are Effective Handoffs so Important?

• Absence of effective handoffs:– Causes avoidable death and disability in

US healthcare each day• APACHE risk 600+% when no handoff occurs

– Drives extended length of stay and higher readmission rates

Why Are Effective Handoffs so Important?

• Absence of an evidence-based face to face handoff is: – a common reason for The Joint

Commission, federal and state regulatory citations

– a barrier to the clinical and financial success of your practice or program

– a commonly cited cause of events leading to malpractice

What Is an Effective Handoff?

• Key components of an effective handoff process include:– Patient name– Room number and bed assignment– MR # or acct #– Meds– Allergies

What Is an Effective Handoff? Key Components continued

– Active problems– Resuscitation status– If-then statements of likely events – Task list IF

Temperature spikes above 39THENRe-culture and add Vancomycin IV

What Is an Effective Handoff?Key Components continued

Webinar Live Vote Question:

– In the past week, what percentage of the handoffs you have participated in included all the components of an effective handoff?

What Is an Effective Handoff? Key Components continued

– Handoffs documented as most effective and consistent by The Joint Commission and safety literature when they occur face to face in a distraction free environment

What Are the Barriers to Safe Handoffs?

– Time constraints– Culture of my program– Absence of a good tool– Distractions when trying to do

handoffs

What Are the Barriers to Safe Handoffs?

Reply in the chat window.

Can IM CrossCover Be an Effective Tool That Tackles Your Local

Barriers?

Y E S • Clinically effective• Time saving

Can IM CrossCover Be an Effective Tool That Tackles Your Local

Barriers?

• Because billing and CrossCover data share 70% of content, a significant time and efficiency savings occurs when shared concurrently– use of technology workflow reduced

time needed to construct a sign-out from 41.2 (range 8 -82) minutes to 27.1 (range 10-15) minutes* * The Veteran Affairs Shift Change Physician to Physician

Handoff Project, February 2010, vol 36. No 2

Can IM CrossCover be an Effective Tool That Tackles Your Local Barriers?

Continued

• Use of the ADT feed to auto-populate multiple options saves even more physician / provider time

• Time saved creates space for face to face handoffs

Can IM CrossCover Be an Effective Tool That Tackles Your Local Barriers?

Continued

• Risk to hospitalized patients is dramatically reduced when safe, evidence-based hand- offs occur

• Risk management literature suggests similar gains in safety when used for complex, high-risk patients outside of the hospital

Additional Uses and Potential Benefits: Inpatient

• CrossCover is shared with charge

nurses/ nursing supervisors• CrossCover is shared with rapid

response teams• CrossCover is shared with case

management

Additional Uses and Potential Benefits: Across the Continuum

• CrossCover is shared with community PCPs as a daily update ahead of discharge– Captures many of the meaningful use

clinical continuity data points

How Do We Implement Use of IM CrossCover Locally?

• Map out your current process for

handoffs– What works?– What doesn’t?– What steps are happening inconsistently

or not at all?• Identify safety and inefficiency issues

inherent in your current process

How Do We Implement Use of IM CrossCover Locally?

Current Process for Handoffs• What is working?• What should change?• How will I measure if

change resulted in improvement?

• Find advocates

Change is implemented• What happened?• What was consistent?• What did not happen? • Collect feedback

Analyze• Identify issues of safety• Define efficiencies /

inefficiencies• What was unexpected?• Summarize observations

Next Steps• Keep, modify or abandon

the implemented change?• Another PDSA?

• If yes, what?

How Do We Implement Use of IM CrossCover Locally? continued

• Begin a trial of use among “the

willing” / early adopters• Measure successes and share their

stories– Time saved– Harm avoided

How Do We Implement Use of IM CrossCover Locally? continued

• Study results and analyze gaps in use or

barriers• Develop a plan for spread

– Align additional incentives within your program

– Tell patient care stories– Engage colleagues who support this work from

risk, safety, quality “program management”

Using Ingenious Med’s CrossCover Function to Save Lives and Save

Time Glenn D. Focht. M.D., Patient Safety and Operations Consultant, IM

imgldafo@gmail.com

Sarah TipsinMarketing Coordinator

sarah.tipsin@ingeniousmed.com

Appendix Closing the Safety Gap in Patient Handoffs: Leveraging Technology to Build the Safety Netby Glenn D. Focht, M.D., Patient Safety and Operations Consultant, IMhttp://ingeniousmed.com/request-a-white-paper/

Bibliography / Additional References Nasca T.J.: ACGME Resident Duty Hours Task Force (Task Force). Accreditation Council for Graduate Medical Education. Oct 28, 2009.

The Joint Commission: Sentinel Event. http://www.jointcommission.org/sentinel_event.aspx University of California, San Francisco; SFGH Dept. of Medicine: Investigation Highlight: Improving Patient Safety. Frontiers of Medicine (7) Fall, 2008.The Joint Commission, Sentinel Event Data: Root Causes by Event Type. 2004-1Q 201. http://www.jointcommission.org/assets/1/18/Root_Causes_by_Event_Type_2004-1Q2012.pdfThe Joint Commission National Patient Safety Goals. http://www.jointcommission.org/standards_information/npsgs.aspxUnderstanding and Improving Patient Handoffs. Jt Comm J Qual Patient Saf 36 (Feb 2010).Emily S. Patterson, Ph.D, and MD, MS Robert L. Wears. "Patient Handoffs: Standardized and Reliable Measurement Tools Remain Elusive." Jt Comm J Qual Patient Saf 36 (Feb 2010): 52 – 61.UCSF Patient Safety: How Can You Prevent Medical Errors; Powerpoint; Arpana R. Vidyarthi, MD etc. Knaus W.A. et al.: The APACHE III Prognostic System: Risk Prediction of Hopsital Mortality for Critically Ill Hospitalized Adults. Clinical Investigations in Critical Care. Chest 1991; 100:1619-36, Dec 1991. Glasheen J.: Designed to Harm; The building Blocks of an inequitable healthcare system. The Hospitalist Dec 2010.The Veterans Affairs Shift Change physician to physician handoff project, Feb 2010, vol 36 No 2The Veterans Affairs Shift Change physician to physician handoff project, Feb 2010, vol 36 No 2

Additional References continued Vidyarthi A.R. Patient Safety: How Can You Prevent Medical Errors

Vidyarthi A.R. Patient Safety Issues in OBGYN.Kitch B.T., et al.: Handoffs Causing Patient Harm: A Survey of Medical and Surgical House Staff. Jt Comm J Qual Patient Safety, 34:563-570d. Oct. 2008.Patterson E.S; Wears R.L.: Patient Handoffs: Standardized and Reliable Measurement Tools Remain Elusive. Jt Comm J Qual Patient Safety. 36: 52-61. Feb. 2010.Anderson J., Shroff, D. et al.: The Veterans Affairs Shift Change Physician-to-Physician Handoff Project. Jt Comm J Qual Patient Safety. 36(2):62-70. Feb. 2010.Young J.Q.: Ask the Expert: Patient Safety During Transitions in Care. Focus, IX(2): 183. Spring, 2011.Kaplan L.J. M. F., et al.: Uncovering System Errors Using a Rapid Response Team: Cross-Coverage Caught on the Crossfire. Journal of Trauma-Injury Infection and Critical Care. 67(1):173-179. Jul. 2009Morin M.J., Edens M.: Resident Sign-Out: One Size Does Not Fit All. Hasbro Children's Hospital.AHRQ, Clinical Information, EPC Evidence Reports: Making Healthcare Safer: A Critical Analysis of Patient Safety Practices . Chapter 42. Information Transfer; Subchapter 42.2: Signout Systems for Cross Coverage. http://www.ahrq.gov; http://www.hhs.govShearer A.: Fishbone / Resident Signout System: A medical communication tool used by all Lifespan teaching hospitals in Rhode Island. Retrieved from Lifespan.Peterson L.A., et al.: Does housestaff discontinuity of care increase the risk for preventable adverse events? Ann Intern Med 121:866-872, Dec. 1, 1994.

Additional References continued Sutcliffe K.M.: Communication Failures: An insidious contributor to medical mishaps. Acad Med 79: 186-194, Feb. 2004.

The Joint Commission: Handoff Communications: Toolkit for Implementing the National Patient Safety Goal. Oakbrook Terrace, IL: Joint Commission Resources, 2008.Department of Veterans Affairs (VA) Iowa City Health Care system: Health Care Hand-Off Communication. 106-107, Dec. 22, 200. (last accessed Nov. 2007, unavailable outside VA).U.S. Department of Veterans Affairs: Findings and Recommendations for Improving Patient Handoffs in the VHA. Dec. 7, 2005. (last accessed Nov. 2007, unavailable outside VA).Horwitz L.I. et al.: Transfers of patient care between house staff on internal medicine wards: A national survey. Arch Intern Med 166:1173-1177, Jun. 2, 2006.Solet D.J., et al.: Lost in Translation: Challenges and opportunities in physician-to-physician communication during patient handoffs. Acad Med 80:1094-1099, Dec. 2005.Patterson E.S. et al.: Handoff strategies in settings with high consequences for failure: Lessons for health care operations. Int J Qual Health Care 16:125-132, Apr. 2004.Roughton V.J., Severs M.P.: The junior doctor handover: Current practices and future expectations. J R Coll Physicians Lond 30:213-214, May-Jun. 1996.Vidyarthi, A.R., et al.: Managing discontinuity in academic medical centers: Strategies for a safe and effective resident sign-out. J Hosp Med 1:257-265, Jul.-Aug. 2006.Shaw G.: Handoff Rx: Knowing what to say and how to say it. Standardized forms, written and verbal reports help residents avoid potential problems during transfers. ACP Observer, pp. 6-11, Oct. 2006.

Additional References continued

Arora V., et al.: Communication failures in patient sign-out and suggestions for improvement: A critical incident analysis. Qual Saf Health Care 14:401-407, Dec. 2005.Ram R., Block B.: Signing out patients for off-hours coverage: Comparison of manual and computer-aided methods. Proc Annu Symp Comput Appl Med Care, pp. 114-118, 1992.Volpp K.G.M., Grande D.: Residents’ suggestions for reducing errors in teaching hospitals. N Engl J Med 348:851-855, Feb. 27, 2003.Van Eaton E.G.: A randomized, controlled trial evaluating the impact of a computerized rounding and sign-out system on continuity of care and resident work hours. J Am Coll Surg 200:538-545, Apr. 2005.Lee L.H., et al.: Utility of a standardized sign-out card for new medical interns. J Gen Intern Med 11:753-755, Dec. 1996.Behata B., et al.: A conceptual framework for studying the safety of transitions in emergency care. In Henriksen K. (ed): Advances in Patient Safety. Agency for Healthcare Research and Quality, 2005, vol 2, pp. 309-321. http://www.ahrq.gov/downloads/pub/advances/vol2/behata.pdf (last accessed Dec. 15, 2009).Doyle E.: To keep nurses in the loop, this hospital gave them access to its sign-out system. Today’s Hospitalist, pp. 20-23, Jul. 2006Sidlow, R., Katz-Sidlow R.J.: Using a computerized sign-out system to improve physician-nurse communication. Jt Comm J Qual Patient Saf 32:32-36, Jan. 2006.