Quality Improvement Plan for Hospital Patient Transfers

Introduction

Communication best practices and documentation standards can appear straightforward, yet when left unaddressed they may generate complex problems requiring serious corrective effort. Quality improvement within healthcare can be extremely beneficial in resolving such problems before they escalate.

This Quality Improvement Plan is based on problems experienced at a community hospital located in Watertown, NY. This environment was targeted because of a documented lack of effective patient transfer communication between departments. The documentation process has been identified as problematic, and a quality improvement effort has been applied to address it.

This plan describes in detail the many facets of this process in a real-world context. The goals and objectives are to significantly improve patient care quality through better communication at the patient-transfer level within this hospital. The plan details how data and information regarding perceived failures may be reorganized into a more complete system that specifically improves communication, enhances patient quality, and conserves valuable resources — ultimately making the organization stronger and better equipped to provide the care that patients need.

Goals and Objectives

The purpose of this performance improvement (PI) plan is to discuss the effects of quality improvement (QI) methods in a practical clinical situation. The basis for this discussion revolves around the issue of patient transfers. The problem targeted for quality improvement is the documentation process when patients are moved from one unit of care to another — specifically from a lower level of care to a higher level of care. The specific issues involve information tracking and effective patient handoffs.

Three methods of QI will be introduced that may be helpful in resolving these problems. The discussion then focuses on the information technology (IT) applications that may be effective in approaching these issues. Finally, the importance of benchmarks and milestones in QI management is examined to highlight how these ideas may best be incorporated into the situation at hand.

The main issue to be addressed in this organization concerns effective documentation. It has been identified that the current documentation method omits some critical information. One example of a critical piece of missing information is the circumstances or criteria that justified moving a patient from one unit of care to another. For example, when a patient is moved from the Medical/Surgical unit to the intensive care unit (ICU), the documentation should clearly indicate the reasons for this decision so that the nursing staff can quickly understand its basis and provide the appropriate level of care efficiently.

Scope and QI Activities

This is especially important with regard to ICU transfers, where the reason for the transfer may represent critical data about a patient's condition in a life-or-death situation. Closing this documentation gap is therefore the central goal of this QI initiative.

The QI activities associated with this plan revolve around the issues of communication and patient transfer. To best understand the problem, the scope of this plan must be comprehensive and must involve all key stakeholders within the environment. The plan is focused on the transfer of patients and the communication of the appropriate data associated with each patient being transferred. All activities are grounded in this premise and directed accordingly.

Data Collection and Meeting Best Practices

To fully understand the problem, more information is needed to improve the quality of patient care. Both technology and human involvement are required to achieve the desired improvements at this hospital. Aligning these elements is central to the research process and to the selection of the most beneficial QI strategy.

There are many sources of data that can help guide organizational council meetings. Meetings can be expensive for an organization. Not only do participants spend time in the meeting itself — a direct cost in terms of wages — but they are also away from their other job responsibilities during that time, representing an indirect cost. Therefore, formal meetings should only be held when the situation genuinely merits it, since many organizational issues can be resolved without convening a meeting.

Several best practices are associated with effective meetings. One of the most valuable is the use of a formal agenda distributed before the meeting takes place. When group members receive the agenda in advance, they have an opportunity to consider the topics beforehand, allowing them to contribute more substantively during the allotted time. As a result, the group can offer more insightful perspectives rather than formulating responses to unexpected topics on the spot. A well-trained facilitator can further help keep the discussion on track so that all intended topics are covered efficiently.

Time management models can also increase both individual productivity and meeting effectiveness. For example, the POSEC method — which stands for Prioritizing by Organizing, Streamlining, Economizing, and Contributing — is particularly well suited to individual task management (Finkelstein, 2010). Finkelstein noted that this method enables a person to break goals and tasks into smaller projects, and that completing individual tasks effectively makes the remaining goals easier to accomplish. Applying such an approach to group meetings would provide a strong foundation for improving their overall effectiveness.