YOU’VE BEEN FLAGGED Improving Patient Outcomes Using a Patient Admission Notification System

1. YOU’VE BEEN FLAGGED Improving Patient Outcomes Using a Patient Admission Notification System Team : Kim Norman (Clinical Nurse Educator). Katie Cave (Patient Care Coordinator), Sandra Davidson (Unit Clerk), reviewed by leadership team What is it? An electronic Patient Admission Notification System screens, flags and draws attention to a specific clinical issue through notification, reporting and communication. With increasing interest in health informatics and communication technologies this system supports collaborative healthcare delivery and improves patient outcomes. The costs associated with inefficient communication include inadequate clinical time management and poor or delayed treatment planning. Why is it needed? Within the delivery of health care patients frequently pass between community and acute care settings. The patient often becomes the chief source of communication for complex medical situations, meaning transitions between units creates an opportunity for healthcare errors. As a result, all interdisciplinary health care professionals involved need to share and discuss patient information. Within the Fraser Health Renal Program there have been many undocumented difficulties and gaps in communication when chronic renal failure patients are admitted to acute care facilities. Having an electronic patient notification system applied to patients’ medical profiles facilitates practice improvement initiatives, allocation of resources, validation of required services, and assists in knowledge transfer by improving the accessibility and quality of information. How the Patient Admission Notification system works: • Quality Care and Patient Safety • Effects of implementing the notification system: • The Kidney Care Clinic has been able to more efficiently follow-up with patients whose eGFR levels have dropped while admitted in hospital, and initiate modality education prior to discharge. • The Peritoneal Dialysis Unit has been able to seamlessly continue care for patients requiring antibiotic therapy due to peritonitis, prior to patients transitioning home. • The Hemodialysis patients’ Advanced Care Plans have been honoured and respected when admitted into acute care facilities as a result of increased communication and collaboration. • Initiation: Patient Notification System • Once patients are registered with the Fraser Health Renal program an automatic flag is applied to their medical profiles. • If a patient is admitted into an emergency room within a Fraser Health acute care facility a report is automatically printed and identifies the patient as being followed by the Renal Program (see report below) • The report specifies which modality of treatment the patient is currently receiving • In-patient Reports • Once patients are admitted into an acute care facility the CPI works by: • Assisting with knowledge transfer by improving accessibility and quality of information • Increasing interdisciplinary communication • Preventing delayed treatment and discharge planning • Assisting the Renal Unit Clerks in locating patients admitted to inpatient units and saving valuable time “I was made aware that our patient was discharged from hospital with an eGFR of 13. I made a call to the patient to follow-up post discharge. 1 week later they were receiving hemodialysis treatment” (Clinical Resource Nurse, Kidney Care Clinic) “The access to a list of inpatient registered renal patients has been very valuable to my daily social work practice.  I have been able to prioritize my day much more effectively as a result of having daily access to the potential needs of the patients.  It is an effective communication tool that ultimately provides enhanced clinician knowledge that translates into better patient care as it improves interdisciplinary and interdepartmental communication & patient care planning.” (Social Worker, Hemodialysis) Report printed in Emergency Room upon registration of patient Admissions Report printed by Renal Staff Testimonials “I no longer have to search for information on admitted patients” (Unit Clerk, Peritoneal Dialysis) • Outcomes • The outcomes of applying the patient notification system include: • Timely referrals to nephrologists and other health care professionals • The ability to keep accurate statistics of renal patients’ visits to acute care centers throughout Fraser Health • Patients receiving continuity of renal care whether they belong to the Hemodialysis Unit, Peritoneal Dialysis Unit or Kidney Care Clinic References 1) Campbell, S.M., Braspenning, J., Hutchinson, A., Marshal, M., (2002) Research methods used in developing and applying quality indicators in primary care. Qual safe Care; 11:358-364. 2) Hodder . A, (2006), Communication Systems in Healthcare. Clinical Biochemistry Revisons; 27(2): 89-98. 3) McGaw. J., Conner.D.A., Delate. T.M., Chester.E and Barnes.C.A, (2007). A multidisciplinary Approach to Transition Care: A Patient Safety Innovation Study. The Permanente Journal, 17;4, 4-9 4) Sickkids (1999-2009). Clinical Informatics. Htt://www.sickkids.ca/Nursing/Clinical%20informatics%20and20Technology/CIT-clinical-informatics/index. Retrieved April 26th 2010. 5) The Australian Council on Healthcare Standards (ACHS), (2009). Clinical Indicator Program 2009. Published by ACHS