pauline calleja - barcaldine hospital and mphs - information transfer for multi-trauma patients on...
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Information Transfer for Multi-
trauma Patients on Discharge
from the Emergency
Department DR PAULINE CALLEJA, PROF LEANNE AITKEN, PROF MARIE COOKE
CENTRAL WEST HOSPITAL AND HEALTH DISTRICT, PRINCESS ALEXANDRA HOSPITAL, GRIFFITH UNIVERSITY
Outline Background
Research method
Study context
Outcomes:
How to improve information flow at handover to improve patient outcomes
Development of a minimum dataset and
documentation requirements
Identification of barriers and conduits to information transfer for patients at vulnerable transition points
Background Why this? What’s the problem?
What the literature says:
Transition points are most vulnerable, at change of
practitioner/shift but more so at change of
department/transfer inter-hospital or ward
Information loss at transfer affects patient outcomes,
errors such as missed injuries, incorrect or repeated
treatments and disrupts continuity of care
Communication cornerstone of care, but complex
Complexity increased with number of people involved
Phase 1
Context appraisal
Literature review
Focus groups
Staff survey
National and international
practices
Patient chart audit
Phase 2
Strategy development
Strategy development
working group
Rationalisation and approval of
proposed strategies
Phase 3
Strategy implementation
Implement strategy devised
in Phase 2’s working group
with use of practice
development framework
Phase 4
Strategy evaluation
Focus groups/ change agent information
Staff survey
Patient chart audit
Study Context
The setting for this study was one major metropolitan
ED with a trauma service in Queensland, Australia
The context of the hospital was a tertiary referral centre, undergoing magnet credentialing
Information flow at handover
Variability in practice
Continuity of staff
Being able to put together a picture of the
patient from information provided
All affected by values and context of staff
involved
Improving information flow
Understand the variables involved
Shared understanding of patient be expectation
of handover
Agreed minimum data set
Embed data set, based tools on it
Clinician driven change
MDS & documentation requirements
Needs to be memorable, practical and structured
We modified SBAR to provide the overt structure and
modified the details
Base tools on the dataset required
Dataset may also serve dual purpose for data
collection for patient health outcomes studies
Documentation…specifically
Clinicians in ED - awareness of documentation quality
Documented information most valuable
Information discrepancy
Clarity, relevance and ease of use of forms paramount
Increased patient acuity = decreased documentation
Barriers & conduits
Generally the same things,
Positives and negatives of each other
Depended on:
the clinician’s choice of action,
knowledge
attitude
environment factors
practices they subscribed to
Barriers and conduits
Variability
Expectations
Knowledge and skills
Information handed over
Information documented
Processes used
Continuity
Clinician
Documentation provides full story
Time of day of transfer
Time to document in resus
Processes
Information discrepancy
Putting the
pieces together
Missing pieces
Ease of navigation to information
Surprises at handover
Expectations and actions aligned
Conclusion clear, concise, pertinent, communication
relevant, clear documentation that
accompanies the patient
both sender and receiver involved in
handover
standardised processes
expectations differ based on practice area