School of Medicine and Health Sciences Poster Presentations
Improving the One Call Inter-Hospital Transfer System to Improve Patient Safety and Efficiency of Care
Poster Number
321
Document Type
Poster
Status
Medical Resident
Abstract Category
Quality Improvement
Keywords
Patient safety, Quality Improvement, Systems Improvement, One Call, Internal Medicine
Publication Date
Spring 2018
Abstract
Introduction: As a tertiary care health center, George Washington University Hospital accepts transfers of care from regional hospitals for patients who need a higher level of care. Due to the high level of care that these patients require, they are often at increased risk of bad outcomes or even death due to their clinical state. However, since these patients are admitted directly to GW Hospital under inpatient status, they bypass the well-developed triaging systems that are in place in the emergency department. Given the relatively high proportion of patient safety concerns surrounding this admission system, a project was undertaken with a goal of expediting time-to-evaluation by the general medicine admitting physician teams.
Methods: Key stakeholders around the One-Call Hospital transfer system were engaged, including the internal medicine medical residents, nurses, charge nurses, nursing administration, and bedboard. A first PDSA cycle was attempted with the goal of creating an order-set protocol to be executed by floor nurses. This PDSA was unsuccessful and attributed to difficulty identifying individuals who could easily lead such changes as well as concerns about educating all floor nurses about this potential process change. A second PDSA cycle was attempted in which BedBoard associates were given a TigerText account and instructed to text the Medicine Admitting On-Call Officer once patients arrived by ambulance (in contrast to the original system of having the floor nurse call the admitting team once the patient had been situated floor). During the PDSA cycle, the original system of having floor nurses notify the admitting teams was kept in place.
The primary outcome will be the difference in time from arrival at GW Hospital to the time of initial admission order placed by the internal medicine admitting teams by review of the electronic medical record.
Results: Final data on this PDSA cycle will be available by March 2018. Preliminary verbal reports from admitting residents physicians suggests that they have received notifications from BedBoard about the arrival of transfer patients an estimated 30 minutes before receiving notifications from floor nurses in some instances. Admitting resident physicians had a highly positive subjective view of this process change.
Conclusions: Preliminary evidence suggests that the second PDSA is successful and will facilitate earlier evaluations of transferred patients by internal medicine resident teams. Since these patients occasionally arrive from their transferring facilities with poor or deteriorating clinical conditions, this apparent decrease in time-to-evaluation is viewed as a tremendous success. Exploration of expanding this process to other departments may be warranted.
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1
Improving the One Call Inter-Hospital Transfer System to Improve Patient Safety and Efficiency of Care
Introduction: As a tertiary care health center, George Washington University Hospital accepts transfers of care from regional hospitals for patients who need a higher level of care. Due to the high level of care that these patients require, they are often at increased risk of bad outcomes or even death due to their clinical state. However, since these patients are admitted directly to GW Hospital under inpatient status, they bypass the well-developed triaging systems that are in place in the emergency department. Given the relatively high proportion of patient safety concerns surrounding this admission system, a project was undertaken with a goal of expediting time-to-evaluation by the general medicine admitting physician teams.
Methods: Key stakeholders around the One-Call Hospital transfer system were engaged, including the internal medicine medical residents, nurses, charge nurses, nursing administration, and bedboard. A first PDSA cycle was attempted with the goal of creating an order-set protocol to be executed by floor nurses. This PDSA was unsuccessful and attributed to difficulty identifying individuals who could easily lead such changes as well as concerns about educating all floor nurses about this potential process change. A second PDSA cycle was attempted in which BedBoard associates were given a TigerText account and instructed to text the Medicine Admitting On-Call Officer once patients arrived by ambulance (in contrast to the original system of having the floor nurse call the admitting team once the patient had been situated floor). During the PDSA cycle, the original system of having floor nurses notify the admitting teams was kept in place.
The primary outcome will be the difference in time from arrival at GW Hospital to the time of initial admission order placed by the internal medicine admitting teams by review of the electronic medical record.
Results: Final data on this PDSA cycle will be available by March 2018. Preliminary verbal reports from admitting residents physicians suggests that they have received notifications from BedBoard about the arrival of transfer patients an estimated 30 minutes before receiving notifications from floor nurses in some instances. Admitting resident physicians had a highly positive subjective view of this process change.
Conclusions: Preliminary evidence suggests that the second PDSA is successful and will facilitate earlier evaluations of transferred patients by internal medicine resident teams. Since these patients occasionally arrive from their transferring facilities with poor or deteriorating clinical conditions, this apparent decrease in time-to-evaluation is viewed as a tremendous success. Exploration of expanding this process to other departments may be warranted.