Safer Handover
Rapid Improvement Event
9th – 11th May 2017
OUTBRIEF
Context (Reason for Action)
• Handover key stream of Safer Salford Programme
• Handover between services and professionals was identified as
a key safety risk
• Frustration across the system regarding current processes and
impact on workloads
• Event created to bring together primary and secondary care to
co-design effective processes
• Seamless patient journeys underpin our ambition for integrated
care
• Real willingness to work together to effect change jointly
Focusing on Value:
Statement
All information relevant to my care must be reliably
communicated to me and those supporting me in a
clear, accurate and unambiguous manner. It must
be readily available and ensure that responsibility for
actions are clearly set out (v.3)
Safer Handover
Referral from primary to secondary
care
OUTBRIEF
Current State
Key messages:
Top 3 observations
• Differing GP Practice referral processes are a barrier to
standardisation across the board.
• A lack of understanding of each others internal
processes and the associated unintended consequences
• Its complicated!
Top 3 waste/measures
• Duplication of effort for all AND unnecessary
communication
• It can take up to 114 days for a standard referral but
ONLY 30 minutes value added for patient
• 84 steps in the current process but ONLY 3 value added
for the patient
Key gaps to address in future state
• Multiple handoffs create risk
•
Lack of opportunity for primary and secondary care
clinicians to have a clinical conversation
Ideal State
Key messages:
Put the patient at the centre of the
process and empower them
What will improve?
• Patient safety & satisfaction
• Clinician satisfaction
• Create Capacity
How?
• Streamlining, simplifying and
standardising processes.
• Neighbourhood based care
And .. IT infrastructure is CRITICAL
Future State
Key messages:
• Reduce unnecessary
handover … Minimising the
risk of harm
• Handover will be safer
because the process is
simplified, standardised and
electronic
• Shared understanding about
the purpose of the interaction
Added Value Steps:
• From 84 steps to 17
• From 26 handoffs 4
Key actions post event
1.
2.
3.
4.
Set up an information transfer group for clinic referrals
Set up an information transfer group for acute referrals
Test a ‘World Café’-style event
Set up the process to collect and present data by GP
Neighbourhood
5. Test e-check in within a secondary care setting.
6. Test live communication for potential acute admissions (the
Bat phone!)
Lessons Learnt
• It’s a miracle that patients ever get what they need! … But it
happens in spite of the system because people work harder not
smarter
• There is a huge commitment from all to change the system
• Technology MUST enable safe handover
• Recognition that silo working is no longer sustainable, reliable,
efficient and, most importantly, safe
Safer Handover
Improving safety of patient transfers
from secondary to primary care
Current State
Key messages:
Top 3 observations
• Duplication of work and cross-checking
• Lack of certainty/visibility of actions and communications
• Unknown ownership and responsibility for elements of patient
care.
Top waste/measures
• Duplication of communications(Verbal and written)
• Delays in planning and process of discharge
• Time investigating/fact finding for clinical information
Key gaps to address in future state
• Integrated communications/pt records/medicines records
• Reduction of unnecessary communications and handoffs
• Accurate medicines information sharing
• Culture change - Collaboration
Ideal State
What the vision will do: One care organisation with a appropriate access to and sharing of
real-time electronic records , including with the patient, with the right health care professionals
and carers, at the right place at the right time.
Improve:
•
Patient information sharing between primary and secondary and community services.
•
Improve safety and mitigate risk and reduce avoidable patient harm.
•
Having real time relevant information easily available when required via robust
interoperable IT systems.
Added Value Steps:
•
Reduction of waste - Communication steps reduced from 64 steps to 30 for one discharge
•
From infinity handoffs reduced to a more measured and manageable number.
•
Communicate tasks (auditable and visible) rather than documents
•
Improved confidence and trust in the system and people
•
Reduce harm - no readmissions, avoidable deaths or complaints
•
Increases organisation efficiency
•
Improve patient and staff satisfaction
•
Current working model – Rapid discharge for EoL patients
Future State
Key messages:
• “Realistic”: How can the present state be improved?
• Culture change of shared responsibility of patients and resources across the ICO.
• Developing a system to share tasks between secondary and primary care which
with make communications leaner
• Culture change to recognise value and importance of discharge documentation with
preparing of discharge document earlier during admission, high quality medication
review and recording, improved consultant sign off of discharge summaries, more
patient involvement and discharge “counselling”.
• Improved training and feedback on use of IT systems.
• Agreed limited number of high level snomed codes.
• Improve use of read-time Integrated Care Plans.
• Named Care Co-ordinator/person to facilitate all aspects of safe transfer of care
responsibility and/or patient
Key actions post event
• Culture change of shared responsibility of patients and resources across the ICO. – ICO
Exec Team, (SRFT, CCG, SPCT)
• Developing a system to share tasks between secondary and primary care which will make
communications leaner – IT across Primary and Secondary Care – Clinical Comms Group
(Phil and Owain) – prepare all GPs for a task-manager – SPCT Neighbourhood teams
• Culture change to recognise value and importance of discharge documentation with
preparing of discharge plan and document earlier during admission, high quality
medication review and recording, improved consultant sign off of discharge summaries,
more patient involvement and patient discharge “counselling” – Sara Barton
• Improved training and feedback on use of IT systems. – Liz Lamerton, Phil Bell and
Jeremy Tankel
• Agreed we need a standard way to use snomed codes – GDE pathway
• Improve use of read-time Integrated Care Plans – Louise Butler
• Named Care Coordinator/person to facilitate all aspects of safe transfer of care
responsibility and/or the patient – Barbara Slater
Lessons Learnt
• It’s good to talk
• Assumptions and misunderstandings are rife
• IT can do more than we know – if we use it right
• IT can be a barrier – changes are needed
• Reducing the IT options, so everyone does it consistently, can
be better.
Key Messages
What we need support with:
Safer Handover Key Messages and Challenges
Key Messages:
• Safety at handover of care is the priority for everyone
• Handover process needs to be simplified
• We want a joined up system
• We need to reduce the number of handovers and therefore the risk attached
Support required for overcoming challenges:
• Support to move forward further and faster based on the momentum of this event
• Clarity from both organisations on how the action plan will be taken forward and owned
• Governance : Clinical Standards Board? Programmed into two assurance structures.
• Support with developing and making a collaborative approach happen
• IM&T that enables the system to deliver joined up, patient centric care
What we need support with:
Key messages – Bigger Picture
• Heart in Salford to blur boundaries and work as a single health and social
care economy. One team philosophy.
• Drive and desire to redesign and implement a new patient centric system.
Future changes must be clinically led.
• Improving patient flow to ensure the patient is getting the right care, in the
right place, at the right time
• Increasing options for patients and clinicians
• Support for direction of travel and a need to align innovations from this
event into the bigger picture vision
Lessons Learnt
• Bringing everyone involved in the system creates a one team approach
that works for everyone
• Sharing understanding and knowledge of different areas within the system
improves team working and appreciation of workload
• Delegates are champions of safer handover and future change
• A commitment is needed to having ongoing opportunities to take the time
out to improve processes and systems
Summary
Thank you!