Patient Safety in Day Hospital Transition

1. Patient Safety in Day Hospital Transition September 8, 2008 Strategizing Session

2. Outline • Context • Phase I Highlights • Phase II Highlights Patient Safety in DH Transition

3. Context • Patients attending the Day Hospitals (DH) are a vulnerable population at high risk for adverse events • Some patients have multiple interacting co-morbidities and/or complex social situations so that little impact can be made on referring issues • In health care, transitions require special attention Patient Safety in DH Transition

4. Project Questions • What is the communication flow at the different day hospital sites? • Does this meet the community’s needs? • How are ongoing risks currently being managed? • What is the ideal discharge process? Patient Safety in DH Transition

5. Phase I • June to Dec 2007 • Series of focus groups and individual interviews with a broad range of stakeholder groups • Results widely circulated Patient Safety in DH Transition

6. Recommendations on discharge process: • Standardized process that is clearly communicated to patients at admission • Involving patient/family in discharge • Larger pharmacy component in DH • Implement a follow up process Patient Safety in DH Transition

7. Phase II • Chart reviews conducted at 4 four participating sites: Deer Lodge, St. Boniface, Seven Oaks, and Riverview • 100 consecutive discharges • Patients who had attended 3 or more times, discharged on a planned basis • Excluded: rural, MD/RN only, died, moved, hospitalized, and/or discharged self Patient Safety in DH Transition

8. Thank you clinical staff ! Patient Safety in DH Transition

9. Please keep in mind • We believe each clinical team is applying sound clinical management and judgment to each clinical case • This project looked only at how well this comes across in the written communication that is sent out to other clinicians/ agencies Patient Safety in DH Transition

10. Referrals Patient Safety in DH Transition

11. Assessment Letters • Assessment letter in the chart 90% of the time • 70% of the time it is completed by the doctors, 8% by nursing, or 15% by two or more (usually MD/RN) • 20% sent to the FMD alone, while the rest of the time it is sent to the MD, HC and other referring agencies • 63.5% of the time there is chart evidence that the letter was sent by either fax or mail- this may be an overestimate Patient Safety in DH Transition

12. Team Plan/ Care Plan • Majority of the time a care plan was noted to be in the chart • Each site has a unique approach to documenting a care plan with different content/ format/ language by site Patient Safety in DH Transition

13. Review letters/discharge letters • 76% had “discharge letter” • 71% discharge letters had a medication list • Letters were widely distributed but only 50% of the time does chart identify if faxed/mailed out • Format varies between sites Patient Safety in DH Transition

14. Specialized Information Patient Safety in DH Transition

15. Risk for falls Assessment Patient Safety in DH Transition

16. Risk Resolution • 10.5% Family accept risk • 13% Discharge recommendations • 1.2% Discharge follow up • 0.2% Family conference 26% 61% 12% Patient Safety in DH Transition

17. Risk for Social Isolation Assessment Patient Safety in DH Transition

18. Risk Resolution • 2.2% Family accept risk • 7% Discharge recommendations • 1.2% Discharge follow up • No Family conferences 17% 66% 17% Patient Safety in DH Transition

19. Medication Management Risk Assessment Patient Safety in DH Transition

20. Medication Management Recommendations Patient Safety in DH Transition

21. Phase III • Your feedback and recommendations • Consolidated into a report for wide spread distribution • Day Hospital Coordinating Committee will have responsibility for implementing recommendations that relate directly to the Day Hospitals Patient Safety in DH Transition