Hand-off
Tools to assemble all the pieces of primary care data together
This coming Thursday I give a talk to the General Practice Research Group at Otago University.
Otago University is one of the two main medical schools in New Zealand, and is highly regarded internationally for its innovative research and education of top class clinicians.
Some of the General Practitioners in the Department have expressed interest in Lifetime Health Diary™, especially as we are now beginning to be used on the ground by registered nurses in community health settings. Anything that can alleviate pressure points in healthcare delivery, particularly around early interventions and patient engagement, is something of interest to General Practice and I look forward to the opportunity to demonstrate what our product can do.
Topics I will be covering will include…
- How to improve communication between patient, community care provider & General Practitioner.
- Smoother handoffs between different care settings and providers (including better follow up and communication tool after discharge.
- Provide better and quicker understanding of poly-medication regimes.
- Medication Optimisation and measuring patient progress by regimes.
- Health Reconciliation Tool between rest homes, GPs and pharmacists.
- Distance medicine / Rural health.
- Green prescriptions (i.e. exercise and lifestyle recommendations), patient health management & patient safety.
- Preparing for the upcoming 40-year bulge of aging Baby Boomers
I look forward to writing up some notes about GP reaction, comments, and generally what happened at the talk next week.
Yours in health,
Hamish
Better hospital hand-offs for patients with multi-med regimes
Last week I wrote about Hospital hand-offs and medical errors, and how they are a systemic problem in hospitals and that it is an area that needs to be improved.
It is a complex problem, a number of organizations are embarking on projects in attempts to solve the issue. There are various innovative strategies such as Project BOOST and Project RED (Re-Engineered Discharge), which respectively provide a comprehensive toolkit for handoffs and patient-centered interactions to learn about after-care plans following discharge.
Paul Levy, CEO of Beth Israel Deaconess Medical Center in Boston writes about a Senior Resident, Kelly Graham, who helped initiate three simple interventions that dramatically improved patient handoff outcomes.
Recently I met with the CEO from Mercy Hospital in Dunedin, who said that
a better tool for medication hand-offs would help during admissions as well as patient discharges. All too often now the “Hospital Reconciliation Tool” consists simply of patients bringing a bag with all the meds they are on
- we checked with Beth Israel Medical Center in New York, where it is also the same procedure. Conversations we have had with various clinicians indicates that to hope that all medications are all neatly noted down correctly and then made available for clinicians in the hospital to view whenever required is just that, a hope.
We hope we can provide a solution to at least the medicine reconciliation part of the equation soon with our new Med Optimization tool. It should work for hospital handoffs as well as community-based healthcare at pharmacies. If anyone working at a hospital would like to try out a better handoff tool for medication regimes, by all means drop us a line.
Yours in health,
Hamish
Hospital hand-offs and medical errors
If you have ever spent time in an ICU (Intensive Care Unit), you know the story…
People lie in beds on the verge of death, with tubes stuck into their bodies at all angles, respirators forcing life-giving oxygen into their inactive lungs, loved ones holding their hands at their bedside.
What is striking is the impassiveness and professionalism of the staff going about their job, making sure that the bio-chemical reactions of their patients are kept stable as much as possible. I guess it has to be like that as a coping mechanism for the staff in order to cope that with day after day, patient after patient. If you got emotionally involved in an ICU, where so many people end up not making it, you probably would burn out in a short period of time.
The problem is that despite this admirable professionalism, the sheer volume of patient information transmitted as each shift of staff comes in to replace the next means there is lots of opportunity for mistakes to occur. Apparently, such hand-offs take place 4,000 times a day in the hospital, or 1.6 million times per year. Lots of stuff slips through the gaps. But this situation is made much worse by the fact that there is no formalized data transfer system for what is known as “patient handoffs”, where patient data and updates are passed from one clinician to another. It is ad-hoc and lacking structure to a frightening degree.
Taking into account how critical it is to have right information at the right time being transferred in an ICU precisely as is there are very few tools yet to reduce risks during the hand-off process. This area of a hospital life has been always associated with medical and medication errors during geographical transitions (from one floor or department to another), care transition (hospital admissions), staff shift rotations during the day and night and a variety of other transitions that allow for the possibility of miscommunication.
That patient hand-offs are ad-hoc, disorganized, inefficient and have to be improved has become very clear for the Joint Commission Center for Transforming Healthcare. Patient hand-offs are one of the improvement projects the Center embarked on August 2009 in order to reduce the mistakes and improve delivery of healthcare because lives are at stake especially in critical units such as ICU. Better tools are needed.
I will pick up this topic in following posts!
