University of Washington Medical Center

University of Washington Medical Center

University of Washington Medical Center

Surgical Improvement Project

Team 3

Minutes

July 25, 2005

Present: Peter Buckley, Mary Claire Cook. Judi Hubbard, John Loeser, Cindy May, Mary Mentele, and Loretta Stesco.

SIP Support: Yuka Jackson and Virginia McClure

Handouts:

1. Report at Hand-Off

2. Anesthesia Report/PACU Data

3. Pre-op Inpatient report

4. TBA Criteria Released Rooms Available

5. Surgical Improvement Project Rapid Process Improvement #1

Report of Meeting:

1. Report at Hand-Off

Hand-Off (also known as “handovers”) was the main topic of discussion for the meeting. The Joint Commission on Accreditation of Healthcare Organizations [JCAHO] has established new requirements, 2006 Hospital National Patient Safety Goals. Goal 2 is “Improve the effectiveness of communication among caregivers”. A new requirement of that goal is “Implement a standardized approach to ‘hand off’ communications, including an opportunity to ask and respond to questions”. At issue: What is the required information to develop a systematic way (script for report and/or use of standardized forms) to transfer patient information accurately and achieve continuity of patient care when a patient’s care is transferred between providers/units?

Discussion:

  • The necessary information is located on the Anesthesia Record. If an electronic medical record system were employed in Surgical Services much of the information system needs would be immediately addressed. However, both the Anesthesia Record and the Surgeon’s Record contain more information than is required at hand-off.
  • The sequence of “talking about things” creates a summary of the patient’s condition and needs. Additionally, this works as a “mind trigger”.
  • Currently, two forms are employed to further information transmission: The Pre-op Inpatient report and the Anesthesia Report/PACU Data form. These forms are not put in the patient’s chart. Both these forms are stapled with a copy of the med sheet. Both forms may need revision; the Inpatient report should be a standard size (8 ½ x 11) rather than a “slip of paper”.

University of Washington Medical Center

Surgical Improvement Project

Team 3

Minutes

July 25, 2005

Report of Meeting (continued):

Report at Handoff (continued)

  • The estimated time to collect and transfer the information for the two existing forms is considered negligible. Transposition errors were not addressed.
  • At the time of a report from one provider to another, often the recipient of the information is engaged with other tasks. It is imperative to have verbal acknowledgement from the recipient that they have assumed the caregiver role and that an opportunity for questions has been provided. [Note: SIP 4 has addressed this topic and has recommended that the hand-off provider should also provide contact information, i.e. pager, to the receiving provider and encourage them to call with any questions.]
  • Access to CIS is limited and must be expanded to all relevant sites, especially Inpatient, if the information contained therein is to be useful.

Action Items:

1. Mary Claire Cook will develop a Best Practice around this topic. Contained within the report will be an emphasis on blood products.

2. Yuka Jackson will work with Judi Hubbard on the Inpatient form.

3. Dr. Peter Buckley will get a list of the required information for the Handoff.

4. Latex allergy status must be noted in the scheduling process.

2. TBA Criteria

The following guidelines were recommended:

  • TBAs can begin to be scheduled the day before.
  • All scheduled black cases take precedence over red cases (except if same surgeon determines that red must go first).
  • TBAs for Main and Pavilion must be scheduled through a central list at the Main Charge Desk.

University of Washington Medical Center

Surgical Improvement Project

Team 3

Minutes

July 25, 2005

Report of Meeting (continued):

TBA Criteria (continued)

  • TBAs will be scheduled on a first-come, first-served basis.
  • The following criteria must be provided prior to scheduling:
  • Surgeon availability.
  • Patient’s arrival time and location.
  • Anesthesia coverage.
  • Case cart production.

Action Item: Mary Claire Cook and Judi Hubbard will trial getting information to inpatient floors and establish a “pull” system to signal inpatient units.

Next Meeting: Monday, August 8th, 5:00-7:00, SP-2276.

Confidential: This document has been created as part of a Quality Improvement work product at the University of Washington Medical Center under the protection of RCW 4.24.250 &70.41.200(3).

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