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									 “Three things can happen,
    two of them are bad”
                                                               Woody Hayes



       It is the System, not the
         Patient. . . . . Really!!!

www.NIATx.net   Reduce Waiting & No-Shows  Increase Admissions & Continuation
                               Handoffs
                A universal challenge
   • 25% of all ATC errors w/in 15 min of
     handoff
   • Piper alpha oil platform explosion
         – 167 dead
         – Handoff
   • Willy King - Wrong leg noted for
     amputation
         – Handoff


www.NIATx.net   Reduce Waiting & No-Shows  Increase Admissions & Continuation
                   • Unaccompanied minors
                   • Relay races
                   • 911
                   • Football
                   • NASCAR pit stops
                   • Surgery to ICU
                   • Curative care to hospice



www.NIATx.net   Reduce Waiting & No-Shows  Increase Admissions & Continuation
                800000


                700000


                600000


                500000

                             10-25%           30%                   Discharges
                400000
                                                                    Connected
                            connected       connected
                300000


                200000
                                                                                   52% planned
                100000
                                                                                   discharge
                     0
                            Detox      Residential OP/IOP/Meth




                Successful handoffs
www.NIATx.net     Reduce Waiting & No-Shows  Increase Admissions & Continuation
                         Language is key.
     – Have 25 seconds to give as much info as possible.

     – Need standard language:
           • Explode,           Zoom,              I Right,               Silver,     Snap
           • (back)        (tight end) (receiver)                      (lineman) (QB)
           • blah,               blah,               blah,                Silver,     blah.

     – Precise job for each player.

     – Each player has only a few things to do, but
       combinations are endless.

     – Practice, Practice, Practice.

www.NIATx.net        Reduce Waiting & No-Shows  Increase Admissions & Continuation
                     The Big Thing!
                If the handoff fails, it is the system’s fault.


          It is never the patient’s fault!
    If the right process was in place the patient would have
                     continued to the next level of care!




www.NIATx.net       Reduce Waiting & No-Shows  Increase Admissions & Continuation
                A great handoff system
   • Commitment (Take Handoffs Seriously)
   • Giver & Receiver must be a team.
   • Giver owns patient till Receiver signals “done”.
   • Handoff process & preparation are:
          Standardized & Scripted
          Synchronized
          Practiced, Practiced, Practiced

   • Processes & outcomes are measured & fed back.
          Qualitative & quantitative evaluation of preparation & transfer




www.NIATx.net      Reduce Waiting & No-Shows  Increase Admissions & Continuation
 Sentara Health: Surgery to SICU
          – Worked for years to get smooth transfer

          – Surgery televises status to SICU
                • When surgery started, etc.

          – SICU knows what lines to prepare for patient

          – 1 hr. prior, scripted process to relay info

          – Anesthesiologist & patient go together

          – Scripted information to intensivist and nurse

          – Stay till lines hooked & Tx info read out loud.




www.NIATx.net        Reduce Waiting & No-Shows  Increase Admissions & Continuation
                Common strategies
    • Everyone knows who is responsible for what

    • Receiver studies patient info & current status first

    • No interruption during handoff

    • Face to face.

    • Consistent order of information presentation

    • Clear signal that handoff has occurred




www.NIATx.net   Reduce Waiting & No-Shows  Increase Admissions & Continuation
            Manatee Glens - Bradenton
               Detox to outpatient
  Linda Transue & Karen Berner                     • Baseline: 66% No show
                                                   • Change 1
                                                      – OP staff meet pts in detox
 Baseline
                                                      – No significant effect
                                                   • Change 2
       1                                              – Recovering coaches explain
                                                        program/invite
       2
                                                      – No shows 37%
       3                                           • Change 3
                                                      – Recovery coaches + calls to
       4                                                remind 1 day prior
            0   20       40        60        80
                                                      – No shows 30%
                       No sho ws
                                                   • Change 4
                                                      – Coaches+calls+detox come
                                                        as a group when appropriate
                                                      – No shows 26%


www.NIATx.net        Reduce Waiting & No-Shows  Increase Admissions & Continuation
                     We can do this!

            • Mission
            • Passion and commitment
            • A lifestyle; not a job
            • Tools & knowledge to make it achievable




www.NIATx.net     Reduce Waiting & No-Shows  Increase Admissions & Continuation

								
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