Who s on First? Handoff Strategies in the Children s Hospital Children s Hospitals and Preparedness Webinar Thursday, June 29, 2017, at 1:00pm ET/12:00pm CT
OBJECTIVES 1. Identify problems that can occur during handoffs for pediatric patients entering/in the emergency department, hospital, and during a disaster situation. 2. Outline best practices and describe how the children's hospital can prepare to handle handoffs most efficiently. 3. Review two tools that can be used during the course of daily work and in pediatric emergencies or disaster situations. Ultimately, we hope that you will come away from this webinar with several ideas about how you can strengthen communication around handoffs within your children s hospital!
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PRA CREDITS STATEMENT The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The AAP designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity is acceptable for a maximum of 1.0 AAP credits. These credits can be applied toward the AAP CME/CPD Award available to Fellows and Candidate Members of the American Academy of Pediatrics. The American Academy of Physician Assistants (AAPA) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit from organizations accredited by ACCME. Physician assistants may receive a maximum of 1.0 hours of Category 1 credit for completing this program. This program is accredited for 1.0 NAPNAP CE contact hours of which 0 contain pharmacology (Rx) content, (0 related to psychopharmacology) (0 related to controlled substances), per the National Association of Pediatric Nurse Practitioners (NAPNAP) Continuing Education Guidelines. Successful completion of this CME activity, which includes participation in the activity, with individual assessments of the participant and feedback to the participant, enables the participant to earn 1 MOC points in the American Board of Pediatrics (ABP) Maintenance of Certification (MOC) program. It is the CME activity provider s responsibility to submit participant completion information to ACCME for the purpose of granting ABP MOC credit.
FACULTY Jennifer Jewell, MD, FAAP AAP Committee on Hospital Care
FACULTY Toni Gross, MD, MPH, FAAP AAP Committee on Pediatric Emergency Medicine
FACULTY Paul Mullan, MD, MPH, FAAP AAP Section on Emergency Medicine
FACULTY Dana Ramirez, MD, FAAP AAP Committee on Quality Transformation AAP Section on Emergency Medicine
DISCLOSURES The presenters have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this activity. The presenters do not intend to discuss an unapproved/investigative use of a commercial product/device in this presentation.
Handoffs Communication Jennifer Jewell, MD, FAAP
PROBLEMS WITH HANDOFFS
HOW CAN WE IMPROVE?
Use technology CONTENT May be difficult, depending on the type of disaster Content Demographics Code Status Allergies Tubes Consultants Diet Contingency Planning Content Problem List Medications (fluid, oxygen) Hospital Course Lines Vitals/Severity of Illness Action List Summary/Discharge Goals
CONTENT A standardized tool Written and Verbal Consider disaster preparedness
Consistent location, dedicated time Include other staff and patients/families Real-time/face-to-face Clear delineation PROCESS
OTHER IDEAS
TRAINING AND MONITORING
Standardization = Process Utilize technology content SUMMARY Requires tools, training, and practice Disasters create unique challenges for handoffs Use handoffs to review patient information and treatments/diagnoses
Handoffs: Transitions of Care for Children in the Emergency Department AAP, ACEP, ENA Joint Policy Statement Pediatrics October 2016 Toni Gross, MD, MPH, FAAP
TRANSITIONS OF CARE IN THE ED Transitions occur in the emergency department multiple times per day every day
EVERYDAY READINESS
A HANDOFF POLICY SHOULD DEFINE Who? Where? What? How?
POLICY STATEMENT RECOMMENDATIONS Structured and consistent practice Patient and family-centered On the job handoff training Healthcare training curricula Compare handoff practices Include IT
HIGHLIGHTED RECOMMENDATION
HIGHLIGHTED RECOMMENDATION EDs are encouraged to work with local EMS agencies to develop a process or script that encompasses Vital signs Clinical status Care provided History and exam findings Mechanism of injury Safety information
NOT ENOUGH EVIDENCE The AAP does not recommend one method of handoff over others Models: Safer Sign Out, ASHICE, CUBAN, DeMIST, MIST, ISBARQ, SHARED, and SOAP. Supplemental Information contains standardized models.
Practical Solutions: Briefing Checklist Tool Paul Mullan, MD, FAAP
WHAT IS A BRIEFING? Military: o Brief meeting, key members receive instruction and exchange info before task starts Healthcare: o Brief meeting, team chats at start of shift or patient event o Gain situational awareness o Anticipate future circumstances o Efficiency
BRIEFINGS: ED LITERATURE Large academic pediatric ED o Texas Children s Hospital Observational study o 8AM and 8PM briefing checklists at shift transition o PASSED (Pediatric Active Shift Signout in ED) 1 Mullan, PC, et al. A novel briefing checklist at shift handoff in an emergency department improves situational awareness and safety event identification. Ped Emerg Care, 2014 Sep 5 EpubIn Press
1 st 3 rd 1 st Briefing Checklist ED Situational Awareness 2 nd Patient Information 2 nd : Patient Handoff 3 rd Patient Situational Awareness
Briefing Checklist Step #1: Start Time Charge Nurse Introductions
Briefing Checklist Available Beds Resuscitation Roles Staffing
Briefing Checklist Sick Patients 1 st Shift Alert
Briefing Checklist Equipment Safety Tips Step #2: Patient Handoff
Briefing Checklist Step #3: ICU-sick Patients Longest Time Without a Disposition
ED BRIEFING RESULTS: CASE STUDY 98% usage rate 1.7 potential safety events per briefing. Top 3 ICU level patient in the ED (48%) Equipment problems (46%) Staffing shortages (21%) Staff survey: Improved communication, staff satisfaction, situational awareness, safety, and effectiveness of care No change in the perceived time to complete signout
HOW TO INSTITUTE BRIEFINGS? STAGE 1: STAKEHOLDER DEVELOPMENT Draft relevant item list Discuss briefing idea with stakeholders Initial feedback and buy-in
HOW TO INSTITUTE BRIEFINGS? STAGE 2: PILOT Start with your shifts Record start & end times Solicit feedback Make changes & re-pilot ~10 pilot tests
HOW TO INSTITUTE BRIEFINGS? STAGE 3: FEEDBACK 1. Present checklist 2. Review content, compliance method, logistics 3. Revise and Re-pilot
HOW TO INSTITUTE BRIEFINGS? STAGE 4: IMPLEMENTATION 1. Announce implementation date Assure feedback will still be considered but no change for a predetermined period (e.g. 2-4 weeks) 2. Implement 3. Collect Feedback, Revise, Version 2.0/3.0/
HOW TO INSTITUTE BRIEFINGS? STAGE 5: MAINTENANCE 1. Track Compliance 2. Follow-up Noncompliance 3. Iterative Improvements
SITE #2: CHILDREN S NATIONAL MEDICAL CENTER POD-SPECIFIC CHECKLISTS (MAIN ED, RESPIRATORY, MINOR CARE, ETC.)
SITE #3: CHILDREN S HOSPITAL OF THE KING S DAUGHTERS: READ-OUT WITHOUT TRACKING
Transitions of Care in the Emergency Department: Handoff Evaluation Tool' Dana Ramirez, MD, FAAP SAMPLE PHOTO
SURVEY: ED TRAINING DIRECTORS 180 160 140 120 100 80 60 40 20 0 No Uniform Handoffs Policy Standarized Sign Out System Would Improve Communication and Reduce Error Sinha, M. Acad Em Med, 2007(14);2;192-196
WHAT CAN RECEIVERS DO? Actively listen Ask questions Track actions Read-back Be a positive deviant
WHAT A HANDOFF IS NOT Not a comprehensive communication of every detail of the patient's history or clinical course
Handoff Evaluation Tool' Adapted from Farnan et al., JGIM 2010
CME/MOC CREDIT CME Credit: Complete the post activity survey. MOC Part 2: Fill out an attestation document that will be sent out following the webinar. Only physicians can claim MOC Part 2 Must fill this document out, identify ABP ID number AAP staff will email each person claiming CME/MOC 2 credit with their certificate of completion. Email DisasterReady@aap.org with any questions.
QUESTIONS? Dial *1 on your phone to ask a live question. Phone: 888-299-7210 Conference ID: 855263 Can ask questions through chat box in lower left corner. AAP staff or presenters will address unanswered questions via e-mail after the call. Please e-mail DisasterReady@aap.org to receive info on future events, or follow-up as needed.
This webinar is supported by cooperative agreement number 5U38OT000167-04, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the US Department of Health and Human Services.