Selected Podcast
High Acuity Transfers – Guidance Tool for Handoffs-Adult Focus
Dana Faber, Patient Safety/Risk Manager at The Doctors Company, moderates this panel interview on high acuity adult transfers with Denise McCord and Kelly Clement.
Featuring:
Denise McCord Denise is the Director of Risk Management for Yellowstone Insurance Exchange, RRG. She started with Yellowstone in May 2012. She has 27 years of experience in pre-hospital, emergency care and critical care. She also has worked in leadership as the director of an ED, as a patient advocate and in Quality and Risk departments.
Kelly Clement, MSN, RN, CPHRM | Denise McCord, RN, CPHRM | Dana Faber, MS PSL, RN, CPHRM
Kelly Clement, MSN, RN, CPHRM is the Senior Risk Manager for Bronson Healthcare Group.Denise McCord Denise is the Director of Risk Management for Yellowstone Insurance Exchange, RRG. She started with Yellowstone in May 2012. She has 27 years of experience in pre-hospital, emergency care and critical care. She also has worked in leadership as the director of an ED, as a patient advocate and in Quality and Risk departments.
Dana Faber is a registered nurse who earned her Associate Degree in Nursing followed by a Bachelor of Science Degree in Business Management. She has also earned a Master of Science in Patient Safety Leadership. Ms. Faber is a Certified Professional in Healthcare Risk Management (CPHRM). She held the office of 2009/2010 President of the California Society for Healthcare Risk Management (CSHRM). Prior to that she acted as the organization’s Communications Chairperson. Dana is the 2020 Deputy Chair for ASHRM’s Patient Safety Committee, a leader in national healthcare risk management stewardship.
Prior to joining The Doctors Company, Ms. Faber worked as a clinical risk manager in an acute care hospital setting. She has over 28 years of healthcare experience and has spearheaded many patient safety initiatives, including correct-site surgery, safe medication management, pressure-ulcer prevention, pathology specimen handling, EHR documentation, electronic incident reporting practices, communication/disclosure, as well as led the hospital’s patient grievance program.
Prior to joining The Doctors Company, Ms. Faber worked as a clinical risk manager in an acute care hospital setting. She has over 28 years of healthcare experience and has spearheaded many patient safety initiatives, including correct-site surgery, safe medication management, pressure-ulcer prevention, pathology specimen handling, EHR documentation, electronic incident reporting practices, communication/disclosure, as well as led the hospital’s patient grievance program.
Transcription:
Michael Carrese (Host): Welcome to the ASHRM Podcast made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. Visit ashrm.org/membership to learn more and become an ASHRM member. On this episode, Dana Faber, Patient Safety and Risk Manager at the Doctor's Company leads a panel discussion on high acuity transfer communications with Denise McCord, Director of Risk Management at Yellowstone Insurance Exchange, RRG and Kelly Clement, Senior Risk Manager for Bronson Healthcare Group.
Dana Faber: Thank you Michael. Handoff communication is an integral part of healthcare throughout the medical continuum. Inadequate handoff communication is recognized as a potential risk to patients. The complexity of transferring patients to higher acuity care puts these patients at higher risk for communication lapses. Because of this important patient care process ASHRMs, patient safety task force developed a tool to be used as a guide in high acuity patient handoffs from lower to higher level of care. Today's podcast focuses on the adult patient, but the tool is customizable to all patients. Denise, as a Patient Safety Task Force Member, you are an integral part of developing the tool. Can you expand on why the task force felt this tool to be an important one to develop?
Denise McCord: Yes. Thank you Dana. As a team we talk about the project and we decided to tackle it because it became more and clearer that hospitals needed this help with high acuity patients that needed to be transferred out. Communication is the number one problem and causes air and harm if you're missing needed equipment or not having a medication to having families go to the wrong hospital and possibly not seeing their loved ones before surgery or passing away. Communication between the referring and receiving facilities is just critical. Having everyone on the same page saves lives. High acuity patients are busy and complex and when it comes time to transferring these patients, it gets even busier, and it becomes very easy to miss important details. And missing just one detail can be detrimental to the patient. So as a group, so a group of us from the Patient Safety Task Force with different backgrounds and areas developed a simple tool. It was developed for an adult but can easily be customizable to all patients, all situations and besides the ED, people in the ICU and surgery, OB and medical floors can all use this tool.
Dana Faber: Thank you, Denise. Kelly, as a Risk Manager for a large health system, how will this tool assist your clinical staff in high acuity transfers?
Kelly Clement: Well, this tool provides a great guideline to staff when accepting a transfer. We all know how important clear communication is in patient care, but don't always have a lot of standardized forms to help guide that communication that we're having. And when we're receiving a critical patient, it's extremely natural to focus on the critical issue of the illness and overlook some of those other important details. This is an easy to use form that staff can use to ensure that they have the information they need for a safe, smooth, and efficient handoff. I would love to see this tool used with transfers between our own facilities in addition to external transfers that we're receiving into the hospital.
Dana Faber: Of course. Yes. Thank you for that. Denise, what does the tool consist of in the form of content and why are these items important in the context of working across continuum of care? As I know you are a historically a flight nurse, ED nurse.
Denise McCord: Yeah, yes. You know, as a ER nurse, this tool could help in so many ways, in assisting me in not, so I wouldn't miss essential items or a process for good continuous patient care. And the flow to expediting a safe transfer. These high acuity patients are just so difficult. And when you get an order for these, it gets even more difficult to have this tool in place so you don't miss anything. As a flight nurse, I would go to hospitals and I'd only know possibly what the diagnosis was or a symptom. So to have better communication, I would be able to make sure I have the needed equipment or medications that were needed for this patient. And we could have the communication. So patients and family wouldn't leave the hospital or expect to go along with the flight team when they really couldn't go along.
Host: You're listening to the ASHRM podcast hosted today by Dana Faber of the Doctor's Company, joined by Denise McCord from Yellowstone Insurance Exchange, RRG, and Kelly Clement from the Bronson Healthcare Group. The ASHRM podcast is made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. Visit ASHRM.org/membership to learn more and become an ASHRM member.
Denise McCord: So we've set up this tool to flow with the transfer and all the important items to consider. Starting at the top, you know, what kind of patient are you dealing with? The next is the blue area that contains a patient name, date of birth, and the receiving facility. And that important information of who did you talk to and their contact number. Because when you're passing this on to other that, you know, they may not be able to get the same person. Next is the yellow area that has the general consideration. Reminders, such as needed equipment for specific ages or diseases. Medication forms that may need to be completed, belonging reminders, conversations with patients and family, and to document. Documentation is so important in these times. The next important areas that is important. Communication pieces that need to be considered with receiving facilities and the family as well. Sometimes they're forgotten. The gray area is the transfer considerations such as how can this patient be transferred? Are the transfer teams available? How long will it take the teams to get to the patient? The last area is the pink area that includes the specific type of transport and does the team need to be picked up? If so, where? What is the estimated, who is the transporting team and their contact numbers? And who is traveling along with the patient as well? All of this is pretty basic information so we know it is needed, and when you're being pulled in 20 different directions, this tool can really help save the errors.
Dana Faber: Good. Thank you. Kelly, you mentioned the tool can assist in ensuring a smoother transition of care so we're not focusing on just one area with high acuity patients during that transfer. Can you provide us a scenario when you would likely use the tool?
Kelly Clement: Thanks Dana. Yeah, absolutely. There are a lot of scenarios that this would apply for. But the one that kind of resonates with me the most is that we're a trauma one facility and we frequently receive transfers from outlying hospitals. Those hospitals are very busy stabilizing the patient as much as possible for the transfer to our facility. This is obviously a high stress situation. The patients frequently need to be transferred while still somewhat unstable. And so being able to have a guided conversation about the transfer will help alleviate some of those unknowns and stress that the innate when transferring from hospital and it makes sure that everyone is on, is working off of the same information. The outline hospitals will also begin to know what information we're looking for and so it can be prepared for that information when we have our hand off.
Dana Faber: Excellent. Well, thank you Kelly and Denise for your expertise in risk management and this excellent feedback on high acuity transfers. The high acuity tool certainly sounds like it will be a critical addition to already existing transfer protocols. We will certainly be recommending it to our members at the Doctor's Company. The tool is not intended to replace required transfer documents, but to assist with the user in addressing important considerations and communication points. The tool is customizable in word format and can be found at Ashton's website at www.ashrm.org. Thank you again, Kelly and Denise.
Host: You've been listening to the ASHRM Podcast with today's host, Dana Faber of the Doctor's Company and her guests, Denise McCord, Director of Risk Management at Yellowstone Insurance Exchange, RRG and Kelly Clement, Senior Risk Manager for Bronson Healthcare Group. The ASHRM Podcast is made possible by the American Society for Healthcare Risk Management, to support efforts to be safe and trusted healthcare through enterprise risk management. Visit ashrm.org/membership to learn more and become an ASHRM member. Thanks for listening.
Michael Carrese (Host): Welcome to the ASHRM Podcast made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. Visit ashrm.org/membership to learn more and become an ASHRM member. On this episode, Dana Faber, Patient Safety and Risk Manager at the Doctor's Company leads a panel discussion on high acuity transfer communications with Denise McCord, Director of Risk Management at Yellowstone Insurance Exchange, RRG and Kelly Clement, Senior Risk Manager for Bronson Healthcare Group.
Dana Faber: Thank you Michael. Handoff communication is an integral part of healthcare throughout the medical continuum. Inadequate handoff communication is recognized as a potential risk to patients. The complexity of transferring patients to higher acuity care puts these patients at higher risk for communication lapses. Because of this important patient care process ASHRMs, patient safety task force developed a tool to be used as a guide in high acuity patient handoffs from lower to higher level of care. Today's podcast focuses on the adult patient, but the tool is customizable to all patients. Denise, as a Patient Safety Task Force Member, you are an integral part of developing the tool. Can you expand on why the task force felt this tool to be an important one to develop?
Denise McCord: Yes. Thank you Dana. As a team we talk about the project and we decided to tackle it because it became more and clearer that hospitals needed this help with high acuity patients that needed to be transferred out. Communication is the number one problem and causes air and harm if you're missing needed equipment or not having a medication to having families go to the wrong hospital and possibly not seeing their loved ones before surgery or passing away. Communication between the referring and receiving facilities is just critical. Having everyone on the same page saves lives. High acuity patients are busy and complex and when it comes time to transferring these patients, it gets even busier, and it becomes very easy to miss important details. And missing just one detail can be detrimental to the patient. So as a group, so a group of us from the Patient Safety Task Force with different backgrounds and areas developed a simple tool. It was developed for an adult but can easily be customizable to all patients, all situations and besides the ED, people in the ICU and surgery, OB and medical floors can all use this tool.
Dana Faber: Thank you, Denise. Kelly, as a Risk Manager for a large health system, how will this tool assist your clinical staff in high acuity transfers?
Kelly Clement: Well, this tool provides a great guideline to staff when accepting a transfer. We all know how important clear communication is in patient care, but don't always have a lot of standardized forms to help guide that communication that we're having. And when we're receiving a critical patient, it's extremely natural to focus on the critical issue of the illness and overlook some of those other important details. This is an easy to use form that staff can use to ensure that they have the information they need for a safe, smooth, and efficient handoff. I would love to see this tool used with transfers between our own facilities in addition to external transfers that we're receiving into the hospital.
Dana Faber: Of course. Yes. Thank you for that. Denise, what does the tool consist of in the form of content and why are these items important in the context of working across continuum of care? As I know you are a historically a flight nurse, ED nurse.
Denise McCord: Yeah, yes. You know, as a ER nurse, this tool could help in so many ways, in assisting me in not, so I wouldn't miss essential items or a process for good continuous patient care. And the flow to expediting a safe transfer. These high acuity patients are just so difficult. And when you get an order for these, it gets even more difficult to have this tool in place so you don't miss anything. As a flight nurse, I would go to hospitals and I'd only know possibly what the diagnosis was or a symptom. So to have better communication, I would be able to make sure I have the needed equipment or medications that were needed for this patient. And we could have the communication. So patients and family wouldn't leave the hospital or expect to go along with the flight team when they really couldn't go along.
Host: You're listening to the ASHRM podcast hosted today by Dana Faber of the Doctor's Company, joined by Denise McCord from Yellowstone Insurance Exchange, RRG, and Kelly Clement from the Bronson Healthcare Group. The ASHRM podcast is made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. Visit ASHRM.org/membership to learn more and become an ASHRM member.
Denise McCord: So we've set up this tool to flow with the transfer and all the important items to consider. Starting at the top, you know, what kind of patient are you dealing with? The next is the blue area that contains a patient name, date of birth, and the receiving facility. And that important information of who did you talk to and their contact number. Because when you're passing this on to other that, you know, they may not be able to get the same person. Next is the yellow area that has the general consideration. Reminders, such as needed equipment for specific ages or diseases. Medication forms that may need to be completed, belonging reminders, conversations with patients and family, and to document. Documentation is so important in these times. The next important areas that is important. Communication pieces that need to be considered with receiving facilities and the family as well. Sometimes they're forgotten. The gray area is the transfer considerations such as how can this patient be transferred? Are the transfer teams available? How long will it take the teams to get to the patient? The last area is the pink area that includes the specific type of transport and does the team need to be picked up? If so, where? What is the estimated, who is the transporting team and their contact numbers? And who is traveling along with the patient as well? All of this is pretty basic information so we know it is needed, and when you're being pulled in 20 different directions, this tool can really help save the errors.
Dana Faber: Good. Thank you. Kelly, you mentioned the tool can assist in ensuring a smoother transition of care so we're not focusing on just one area with high acuity patients during that transfer. Can you provide us a scenario when you would likely use the tool?
Kelly Clement: Thanks Dana. Yeah, absolutely. There are a lot of scenarios that this would apply for. But the one that kind of resonates with me the most is that we're a trauma one facility and we frequently receive transfers from outlying hospitals. Those hospitals are very busy stabilizing the patient as much as possible for the transfer to our facility. This is obviously a high stress situation. The patients frequently need to be transferred while still somewhat unstable. And so being able to have a guided conversation about the transfer will help alleviate some of those unknowns and stress that the innate when transferring from hospital and it makes sure that everyone is on, is working off of the same information. The outline hospitals will also begin to know what information we're looking for and so it can be prepared for that information when we have our hand off.
Dana Faber: Excellent. Well, thank you Kelly and Denise for your expertise in risk management and this excellent feedback on high acuity transfers. The high acuity tool certainly sounds like it will be a critical addition to already existing transfer protocols. We will certainly be recommending it to our members at the Doctor's Company. The tool is not intended to replace required transfer documents, but to assist with the user in addressing important considerations and communication points. The tool is customizable in word format and can be found at Ashton's website at www.ashrm.org. Thank you again, Kelly and Denise.
Host: You've been listening to the ASHRM Podcast with today's host, Dana Faber of the Doctor's Company and her guests, Denise McCord, Director of Risk Management at Yellowstone Insurance Exchange, RRG and Kelly Clement, Senior Risk Manager for Bronson Healthcare Group. The ASHRM Podcast is made possible by the American Society for Healthcare Risk Management, to support efforts to be safe and trusted healthcare through enterprise risk management. Visit ashrm.org/membership to learn more and become an ASHRM member. Thanks for listening.