¶ … business plan provides a process change for bedside patient handoffs at Samaritan Medical Center, Watertown, New York. An overview of the medical center is followed by its mission and vision statements, and organizational values. A discussion of the assumptions involved together with a breakdown of associated costs involved in the business plan are followed by a discussion of the importance of timely patient handoffs and a description of the proposed bedside handoff protocols for Samaritan Medical Center. Overview of Samaritan Medical Center:

"Samaritan Medical Center (Watertown, New York) is a 294-bed not-for-profit community medical center, offering a full spectrum of inpatient and outpatient healthcare services. From primary and emergency care to highly specialized medical and surgical services, such as cancer treatment, neonatal intensive care, behavioural health and addiction services, and imaging services, Samaritan Medical Centre and its team of healthcare professionals proudly serves the medical needs of our civilian and military community. Quality, compassion and safety are basic principles by which exceptional care is delivered at Samaritan" (Samaritan Medical Centre, 2014, para. 1).

Mission Statement:

"Samaritan shall provide high quality, comprehensive, safe, and compassionate healthcare services to meet the needs of our civilian and military community" (Samaritan Medical Centre, 2014, Our Mission).

Vision Statement:

"Samaritan will be recognized, foremost, as the preferred provider of Inpatient, Outpatient, Emergency, and Long-Term Care services in Jefferson County. Additionally, our health system will enhance selected specialty services to meet the needs of the North Country" (Samaritan Medical Centre, 2014, Our vision).

Values:

In order to succeed as a team, in meeting the healthcare needs of those we serve, Samaritan is committed to (Samaritan Medical Center, 2014, Our Vision):

Honesty

Empathy

Accountability

Respect

Trust

Department of Nursing

Vision:

"The Nursing Department will support and enhance seamless, patient-focused care across the continuum, driven by the needs of the patient and family and accomplished through the collaborative partnership of all disciplines" (Samaritan Medical Center, 2014, Department of Nursing Vision).

Assumptions:

All RN/LPN hours at straight time

No overtime involved

Average RN wage: $33.87

Average LPN Wage: $21.85

Training and preparation hours needed:

Prep time: 3 hours

Staff Meetings: 1 hour each x 4 meetings = 4 hours

Training: 2 hours each x 4 sessions = 8 hours

Costs to facility:

Employee Wages:

Anna Taylor, RN -- Unit champion - to help implement

Costs for Anna Taylor:

Prep time: 3 hours x 32.34 = 97.02

Staff Meetings: 3 hours x 32.34 = 97.02

Training sessions: 8 hours x 32.34 = 258.72

Total Costs: $452.76

RN's: 40

Staff Meetings: 1 hour x 33.87 x 40 = $1,354.80

Training: 2 hours x 33.87 x 40 = $2,709.60

LPN's: 1

Staff Meetings: 1 hours x 1 x 21.85 = 21.85

Training session: 2 hours x 1 x 21.85 = 43.70

Expected Implementation Date: April 1, 2014

Incremental Overtime costs prior to implementation:

Estimated 10 hours per day

14 days (number of days in pay period)

$50.81 (Time and 1/2)

$7,112.70 per pay period x 26 pay periods/year = $171,719.60/year

Decrease in revenue:

Revenue is directly related to HCAHP scores. According to the Centers for Medicare & Medicaid Services (CMS, 2013) 30% of the total reimbursement from Medicare emanates from HCAHP scores. Hospitals that do not achieve goals can expect to see a decrease in their Annual Payment Update (APU) which can be as high as a 2% decrease in revenue (CMS, 2014).

Currently the target goal for HCAHPs on 4 pavilion, as it pertains to communication with nurses, is 77.4% (data obtained from Samaritan Medical Center). The period covering July 2013 to December 2013 for 4 Pavilion, has a mean score of 75%.

Transfers to higher level of care:

Research has shown (Triplett & Schuveiller, 2011; Friesen, White, & Byers, 2008) that bedside report can prevent transfers to higher levels of care. On average a transfer to a higher level of care can result in increased expenses for the patient and the hospital. The average room rate for an ICU bed is $3,957/day, as compared to a Medical/Surgical bed at $1,173/day. Transfers to higher level of care can also increase the length of stay (LOS) from 2-5 days.

Costs Savings:

Incremental Overtime:

Based on similar units that have implemented Bedside handoff, Incremental overtime should decrease. It is estimated that this time will decrease from present 140 hours per pay period to a nominal 10 hours per pay period. This represents a savings of $6,604.60 per pay period.

Reimbursement:

Bedside handoff has been shown to increase patient satisfaction. Primarily this is because patients perceive that the nursing staff is actively communicating with them. This perception is what HCAHPs are all about. By implementing bedside...

These increased scores will reflect positively on the overall scores of Samaritan Medical Center.
Return on Investment: The Return on investment is calculated using only the salaries and wages.

ROI = (gains from investment -- Cost of investment)

Cost of investment

ROI = $174,719.60 - $4,582.71 = $167,136.89

36.47

$4,582.71

$4,582.71

Follow-up:

2 months after implementation will need to review process, HCAHP scores, and overtime: No costs to facility

Proposed Bedside Handoff Protocols

The proposed bedside handoff protocols for Samaritan Medical Center are based on the rationale provided by numerous health care providers as well as guidance from the Joint Commission. For instance, according to Maxson, Derby, Wrobleski and Foss (2012), bedside handoffs between nurses at shift change represents an important process for clinical nursing practice because it provides nursing staff with the opportunity to discuss relevant patient information in ways that promote continuity of care and patient safety. In this regard, Maxson et al. emphasize that, "Bedside handoff allows the patient the ability to contribute to his or her plan of care. It also allows the oncoming nurse an opportunity to visualize the patient and ask questions" (2012, p. 140).

Not only does bedside handoff of patients between nurses at shift change improve the continuity of care, it is also highly congruent with the Joint Commission's 2009 National Patient Safety Goals because it "encourages patients to be involved actively in their care and it implements standardized handoff communication between nursing shifts" (Maxson et al., 2012, p. 141). A patient's journey through the healthcare system is punctuated by many similar exchanges of critical information, or "handoffs," when either the patient is moved from one care setting to another or when the patient's care providers change.

In 2006, the Joint Commission made patient handoffs a National Patient Safety Goal (NPSG) pursuant to the goal of "[improving] the effectiveness of communication among caregivers." For instance, NPSG 2 states that the "primary objective of a handoff is to provide accurate information about a [patient]'s care, treatment, and services; current condition; and any recent or anticipated changes" (cited in Paine & Millman, 2009, p. 33). NPSG 2 also identifies five components that should be included in each patient handoff as follows:

1. Interactive communication that allows for the opportunity for questioning between the giver and receiver of patient information;

2. Up-to-date information regarding the patient's condition, care, treatment, medications, services, and any recent or anticipated changes;

3. A method to verify the received information, including repeat-back or readback techniques;

4. An opportunity for the receiver of the handoff information to review relevant patient historical data, which may include previous care, treatment, and services; and,

5. Interruptions during handoffs are limited to minimize the possibility that information fails to be conveyed or is forgotten (cited in Paine & Millman, 2009, p. 33).

The last item may be intuitively important, but the hospital environment is frequently not conducive to the limitation of interruptions, making this an important issue for health care providers at Samaritan Medical Center.

The Joint Commission mandate is based on several positive outcomes that can be achieved using patient handoff protocols. For instance, Paine and Millman report that, "Handoffs encompass a broad range of information-sharing opportunities, from a simple report on a stable patient between an off-going and an oncoming nurse, to an ambulance crew bringing a critically injured patient into the emergency department" (2009, p. 34). These are vitally important issues for health care providers because inpatients are typically moved from one care setting to another during their hospitalizations, and even in the same setting, one set of health care providers is replaced by another during shift changes, creating a need for timely communications between providers concerning patients' status. In this regard, Paine and Millman (2009) emphasize that:

Transitions in care are an inevitable part of healthcare delivery, whether the patient is moving geographically from one setting to another-emergency department to inpatient unit; intensive care unit to operating room; unit to procedural area; or hospital to home at discharge-or when the patient remains in the same care area but the caregivers go off shift and new physicians, nurses, and other providers come on. (p. 34)

Providing high quality integrated health care in a hospital setting demands clear and ongoing communication between various health care providers and the patient because each provider will add new information to patients' treatment plans (Paine & Millman, 2009). Consequently, bedside handoffs can promote patient safety and also provide patients with a chance to discuss their status and ask questions of health care providers during bedside patient handoffs (Maxson et al., 2012). Moreover, conducting bedside patient handoffs has been shown to reduce readmission rates through improved coordination of care prior…