Gerri Lamb, PhD,RN, FAAN Associate Professor Arizona State University

Gerri Lamb, PhD,RN, FAANAssociate Professor

Arizona State UniversityCollege of Nursing and Health Innovation

Tracking Hospital Transfers and the Quality Improvement Review Tool

The development and evaluation of the INTERACT quality improvement program and Curriculum are supported by grants from the Retirement Research Foundation and The Commonwealth Fund

INTERACT Curriculum Session 2

If you are participating in a teleconference proceed to the next slide for instructions

If you are reviewing this session as a self-learning activity: Proceed to slide # 4 Click the speaker at the bottom of each

slide to listen to the audio If you do not have audio, click on “View” on the

toolbar, and select “Normal” to view the text below each slide – if necessary select “Zoom” to make all of the slide and text visible.


Teleconference Instructions

Call in Number 1-888-808-6959

Conference Code 3588988 #During the call, please mute your line Press * 6

To un-mute your line Press # 6

If the leader is not on the call when you call in, please wait


Welcome and Introductions


This session is designed for the entire interdisciplinary team, including the:

• Project champion and co-champion• DON, key RNs, LPNs, and CNAs• Medical director, primary care MDs, and NPs/PAs• Social workers• Administrators


Gerri Lamb, PhD, RN, FAAN is Associate Professor at the College of Nursing and Health Innovation at Arizona State University in Phoenix Arizona. She is a member of the team that developed and evaluated the INTERACT tools. She is well-known for her research on case management and transitional care for older adults

Dr. Lamb’s work is now focused on coordination of care for older adults across our health care system and assisting patients, families, and health care providers improve care transitions.

[email protected]

mailto:[email protected]

The INTERACT Interdisciplinary Team

Joseph Ouslander, MD Florida Atlantic UniversityLaurie Herndon, GNP Mass Senior Care FoundationRuth Tappen, EdD, RN, FAAN Florida Atlantic UniversitySanya Diaz, MD Florida Atlantic UniversityJohn Schnelle, PhD Vanderbilt UniversitySandra Simmons, PhD Vanderbilt UniversityAnnie Rahman, MSW Miami UniversityJo Taylor, RN, MPH Carolinas Center for Medical ExcellenceAlice Bonner, PhD, GNP Center for Medicare and Medicaid Services

In collaboration with participating nursing homes


Why track hospital transfers Factors linked to hospital transfers Asking the question: can we improve

what we’re doing to reduce hospital transfers?

Using the Quality Improvement (QI) Review Tool

What This Session Will Cover


Please complete the Pre-Session Quiz If you take the Quiz in a paper and pencil format, please

make sure your facility champion or co-champion gets a copy If you are reviewing this session on-line, you can take the on-

line Quiz, or take the Quiz using a hard copy obtained from your facility champion or co-champion, and return it to them

Pre-Session #2 Quiz


INTERACT and Hospital Transfers

The goal of the INTERACT program is to improve the care of nursing home residents by:

Identifying situations that commonly result in transfers to the hospital – and working together to manage them effectively and safely in the nursing home without transfer whenever possible

Tracking Hospital Transfers and The Quality Improvement Review Tool

Why track transfers? Tracking hospital transfers allows you to:

Identify situations that commonly result in

transfers of your residents to the hospital Determine which situations you can

potentially manage effectively and safely in your facility without transfer

Improve quality of care for your residents

Tracking Hospital Transfers and The Quality Improvement Review Tool

Look for patterns in clinical situations that result in transfers

Work together on strategies on situations you believe can be managed safely and effectively without transfers

Tracking Hospital Transfers


Some of the common reasons for transfer of residents to the hospital included: Change in medical status Family expectations Services available within the nursing home Availability and communication with primary

care providers Advance directives of lack of advance care

planning

Common Reasons for Transfers


Lots of factors may be involved Staff involved in the decision may be

unsure and uncomfortable Discovering situations that might have

been safely treated in the facility may also be uncomfortable at first

Transfer Decisions are Complicated


Early detection of signs Stop and Watch

and symptoms Communication with SBAR

primary care providers Early management of Care Paths, File Cards

clinical conditions Discussions with family Advance Care Planning

about hospitalization


Think prevention and early intervention using the INTERACT tools

The different INTERACT tools are meant to be used together in your daily work in the nursing home

The Quality Improvement Review Tool is meant to identify opportunities to improve management of changes in condition

Consider integrating review of hospital transfers into your regular quality process The same principles apply as you review

hospital transfers Look for common situations that you can

work on together Avoid blaming individuals

Quality Review of Hospital Transfers


Retrospective Designed to assist you to review

situations that commonly result in transfers in your facility

The Quality Improvement Review Tool



The Quality Improvement Review Tool Goal

Helpful for: Identifying situations that commonly

result in hospital transfers Determining situations that may be

managed effectively in your facility Improving quality and reducing

preventable transfers

The Quality Improvement Review Tool


1. Background Information

2. Change in Condition

3. Evaluation and Management

4. Transfer Information

5. Opportunities for Improvement

The QI Review Tool: 5 Sections


The Quality Improvement Review Tool Section 1: Background Info


Looking for Patterns in: Section 1: Background Info


The Quality Improvement Review Tool Section 2: Change in Condition


Looking for Patterns in: Section 2: Change in Condition


The Quality Improvement Review Tool Section 3: Evaluation and Management


Looking for Patterns in: Section 3: Evaluation and Management


The Quality Improvement Review Tool Section 4: Transfer Information


Looking for Patterns in: Section 4: Transfer Information


The Quality Improvement Review Tool Section 5: Opportunities for Improvement


Does this situation offer an opportunity to improve care?

Tracking Hospital Transfers


Tracking hospital transfers allows you to study situations that commonly result in hospital transfers in your facility

There are many factors including clinical, family, and nursing home issues that influence transfers and staff attitudes about them

Having a standard tracking and quality improvement process for hospital transfers keep the focus on improving patient care

Key Points of Session 2


The INTERACT QI Review Tool is designed to help your team identify opportunities to improve your transfers and quality of care.

Prevention, early detection and management are central to improving care – once a resident is acutely ill, it is difficult to prevent a transfer.

Each of the INTERACT tools you will learn about in upcoming sessions is designed to help staff identify and manage situations that commonly lead to hospital transfers.

Key Points of Session 2 (continued)


Your facility’s project champion is responsible for coordinating INTERACT implementation. She or he may ask you to complete specific activities before the next teleconference or before you review the next session on-line.

Suggested implementation activities before the next session: Go to the INTERACT website (http://Interact2.net) and print a copy

of the QI Review Tool. Complete the QI Review Tool for a resident who was transferred to

the hospital Talk with other members of your team about factors they think might

have contributed to the hospital transfer Discuss your answers to the question about whether the transfer

might have been prevented.

INTERACT Implementation Activities


http://interact2.net/

For teleconference participants please un-mute the line: Press # 6Please re-mute your line after talking: Press * 6

Questions and suggestions on Session 2 can also be directed to Dr. Lamb by email at:

[email protected]

Please insert in the Subject Line: “Question about the INTERACT Curriculum”

Questions, Suggestions, Comments?


mailto:[email protected]

Session 3:

The Early Warning Tool:Stop and Watch

Champion DON Key RNs and

LPNs Lead CNAs

The Next Session The next teleconference will be held at the same time next week

The topic and participants are listed below


Please complete the Post-Session Quiz and Evaluation If you take the Quiz and complete the Evaluation in a paper and

pencil format, please make sure your facility champion or co-champion gets a copy

If you are reviewing this session on-line, you can take the on-line Quiz and complete the evaluation on-line.

Post-Session #2 Quiz and Evaluation


Gerri Lamb, PhD,RN, FAAN Associate Professor Arizona State University

Documents

Transcript of Gerri Lamb, PhD,RN, FAAN Associate Professor Arizona State University