A Web-Based Tracking System to Facilitate Transfer of Patient Care between Residents in a Multi-Site Academic Anatomic Pathology Department: A Solution to JCAHO and ACGME Mandates for Optimizing Patient “Handoffs”
Jessica L Davis, Tara A Saunders, Enrique Terrazas, Joseph T Rabban. UCSF, San Francisco
Background: Transfer of patient care from one provider to another carries a risk for introducing error, delay, or suboptimal quality of care. These risks are compounded in a training setting where resident-physicians rotate frequently between different patient care services. Recently, both ACGME and JCAHO have mandated hospitals to enact patient care transfer procedures that incorporate both verbal and written communication between the transferring and the receiving physician. We developed a web-based, automated tracking system to facilitate patient handoffs in a multi-site, multi-rotation, academic anatomic pathology department.
Design: The system is a HIPPA compliant web-based Handoff Portal that tracks all incomplete cases on the last working day of each month in our training program's 3 hospitals, including a tertiary care hospital, a county hospital and a Veteran's Administration hospital. Incomplete cases can be organized by resident (transferring or receiving), faculty, specimen number and category of pending issues. The pathology information system at the cancer hospital was programmed to automatically upload these variables from incomplete cases into the Handoff Portal system. At the other hospitals, the variables were manually entered by the transferring resident. On the last working day of each month, the transferring resident confirms their incomplete case data, the receiving resident reviews the list online, and then a verbal discussion occurs. These actions are tracked online with compliance measured by the percentage of total trainees who completed a handoff at the end of the month via both written and verbal documentation.
Results: Since July 1, 2011, the system has been used to track handoffs at the end of each of three 1-month rotation cycles involving 12 rotations at 3 hospitals. A total of 451 cases to be handed off by 28 trainees were tracked. Over the initial 3 months the compliance rate was 93%, 93%, and 86%. Non-compliance trended toward the more senior trainees, in particular, fellows.
Conclusions: A web-based tracking system can facilitate transfer of patient care between residents at the end of rotations. Although automated data entry by linkage to the existing pathology information system reduces labor on residents, the handoff itself represents a system and culture change which may not be as readily adopted by senior trainees. Further study into benefits for turnaround time and quality assurance are needed.
Category: Quality Assurance
Monday, March 19, 2012 1:00 PM
Poster Session II # 279, Monday Afternoon