Assessment of Care Transitions (ACT)

1. Assessment of Care Transitions (ACT) Dr. Ayse P. Gurses Dr. Mahiyar Nasarwanji

2. Objectives To provide a list of good practices during transitions of care To introduce the Assessment of Care Transitions (ACT) tool and describe when/how to use it

3. Handoff reports 1. Solet DJ, Norvell JM, Rutan GH, et al., Acad Med, 2005. • Patients are particularly vulnerable during handoffs • Incorrectly communicated information • Information not communicated at all • Appropriate measures for evaluating effectiveness of handoffs still need to be established and validated1

4. Our Focus • Identify good practices for handoffs • Concentrates on transfers from • OR  ICU • ICU  Floor • Some many not apply to a specific type of transition

5. Good Practice Guidelines Too much variance observed in care transitions Need to follow a concrete guideline to ensure better safety processes are followed

6. ACT (Assessment of Transitions) • See document attached in email • Good practice findings led to a peer-to-peer evaluation tool (ACT) • Face validity: Expert review completed • ACT reviewed by 6 clinical experts, 4 nonclinical experts not directly involved in its development • Will validate it using the Delphi Method • Let Ayse Gurses- agurses1@jhmi.eduknow if you would like to participate as an expert in our Delphi study)

7. Methodology • Literature review • Field studies in 4 sites • One human factors engineer+ one clinician • Expert opinions

8. ACT • Part I- Organizational Level Assessment • Part II – Specific Handoff Level Assessment • Pre-transfer • Telephone handoff • Physical transfer of patient • Pre verbal handoff report • Verbal handoff report • Post verbal handoff reporting

9. ACT Tool

10. ACT: At the Organizational Level Good Practices Handoff policy : Exists and all staff are aware of it and know where to locate Adequate and appropriate training on care transitions and handoffs Consider compatibility of devices across units when making purchasing decisions ACT

11. ACT: At receiving unit prior to verbal handoff • Room ready for patient on arrival • At least one nurse in addition to the primary nurse should be present to receive the patient (dependent on patients condition) • When transferring cables and lines • Cables and lines should be transferred sequentially • Warning should be provided prior to disconnecting • No more than a 30s disruption

12. ACT • Part I: The Organizational assessment • should be carried out once every 6 months • Part II: Specific Handoff Level Assessment • 10-20 random care transitions should be evaluated every 6 months (or as interventions/ changes to the handoff process are introduced)

13. Who should collect data with ACT? • Select an observer who is familiar with the care transition of interest. • Ideal observer: One with a clinical and/or human factors background with some experience in conducting or studying handoffs • Will shadow the patient from about 10-30 minutes prior to the transfer process to about 10 minutes after the conclusion of the verbal portion of the handoff • The observer should not be involved in the transition.

14. We Need Your Help! • Please identify 1-2 people who can be site champions for the OR-ICU and ICU-floor transitions • Clinicians, quality improvement or human factors specialists • Familiar with the handoff process • Willing to conduct observations • Will be acknowledged for their contributions as the “Handoff Improvement Champions” Group in the related publication. • Can only improve handoffs if we collaborate and learn from each other! • Lessons learned (good practices, things to avoid) from various sites will be shared (without any identifiable information)

15. Please Identify your Handoff Site Champions! • Please send us the contact information by August 30thvia email (csts@jhmi.edu): • Will have a special session to work with the Handoff Champions Group on the logistics of the ACT Tool, how to use it, etc. • EVERYONE: Please review the ACT tool and send Ayse Gurses (agurses1@jhmi.edu) any of your comments/additions/edits, etc. THANKS SO MUCH!

16. Handoff/Transitions of Care Toolkit • New material • Assessment of Care Transitions (ACT)  • Participatory user centered design approach Upcoming to tool / checklist development • Reinforcement • Teamwork across unit tool  • Barrier identification and mitigation tool Upcoming • Currently implemented • Transitions of care survey  • Part of HSPOS  • Relational Coordination 

17. Thank you! Ayse P. Gurses, Ph.D. agurses1@jhmi.edu MahiyarNasarwanji, Ph.D. mnasarw1@jhmi.edu