This proposed demonstration SAFER (Standardizing Admissions for Elderly Residents) will address the critical problem of improving the implementation and adoption of specific patient safety practices to ensure effective communication and information flow during transitions of patients and care between nursing facilities (NF), emergency medical services (EMS) and critical access hospitals (CAH). Over 25% of NF residents are transferred to hospitals each year with significantly higher rates among rural NF residents. These transitions highlight significant safety challenges because they involved multiple settings and many different healthcare providers. Poor quality of care during the NF transfer and hospital admission process with missing or inaccurate information may snowball throughout the episode of care. This demonstration will be undertaken by the well-established Maine Critical Access Hospital Patient Safety Collaborative and will involve 14 small, rural hospitals, EMS systems, and nursing facilities that have committed to implement three specific interventions designed to improve communications, information flow, and patient safety in the transition of care for elderly NF residents to the hospital Emergency Department (ED). The interventions will include process mapping and appreciative inquiry of current handoffs, training in communication skills, and the development and implementation of transfer tools such as checklists and universal forms.
The specific aims of this project will be to (1) Implement skills, tools and processes that improve the handoffs between nursing facilities, emergency medical services, and critical access hospitals with admission of elderly residents;(2) Improve the safety of the handoffs through inter-facility and staff communication that results in a reduction in adverse events, missed or inaccurate patient information, delayed treatment, infections and readmissions;and (3) Partner with stakeholders to align interests, address feasibility, avoid duplication of efforts, and increase wide-spread adoption of the safe practices.
Relevance to Public Health Patient safety problems associated with patient handoffs and transfers are widely recognized as among the most challenging in the field. Reducing errors and adverse events (and their attendant human, clinical, and financial costs) is a public health priority.