Transitions from hospitals to the ambulatory setting are high risk periods for patients. The success of efforts to improve transitional care practices likely depends in part on baseline practices and local resources, culture, and leadership. Several studies have suggested that often there is more variation in the performance of best practices within than between hospitals. The goal of this study was to understand baseline transitional care practices across various inpatient units within a hospital prior to implementation of a multi-faceted transitions quality improvement study.
As part of the Partners-PCORI Transitions Study, we conducted a survey of baseline transitional care practices, including whether they were done at all, and if so, who conducted them and how often they were performed. Respondents included nurse directors and other unit-based personnel, including unit-based care coordinators, nurse educators, and staff nurses. Results are presented using descriptive statistics.
We surveyed respondents on 19 different units at one hospital participating in the study. Results are shown in Table 1. In a few cases (e.g., educating patients and caregivers on discharge instructions), completion of tasks was reliably done and the person responsible was consistent across units. In a few other cases, completion of tasks was reliably done but the person completing the tasks was different on different units (e.g., managing patient/caregiver expectations regarding date/time of discharge, done by nurses, interns, care coordinators, and others). However, in the vast majority of cases, completion of tasks varied widely, with some units always completing them and others completing them rarely if at all. In many of these cases, there was often a lack of role clarity. In the best performing units, 24/25 tasks (96%) were mostly or always done, while in the worst-performing units, only 5 of 25 tasks (20%) were mostly or always done.
At one hospital participating in a multi-faceted effort to improve transitional care, there was inconsistent performance of important transitional care tasks and wide variation by unit at baseline. Such variation needs to be understood and managed as interventions to improve care are promoted. Learning from best-performers within a hospital can provide valuable lessons for spreading best practices and maximizing the efforts to improve patient safety during transitions of care.
To cite this abstract:Schnipper J, Magny-Normilus C, Nolido N, Minahan J, Dalal A, Samal L, Thompson R, Labonville S, Crevensten G. Variation in Transitional Care Practices Within a Hospital: Survey Results from the Partners-Pcori Transitions Study. Abstract published at Hospital Medicine 2015, March 29-April 1, National Harbor, Md. Journal of Hospital Medicine. 2015; 10 (suppl 2). https://www.shmabstracts.com/abstract/variation-in-transitional-care-practices-within-a-hospital-survey-results-from-the-partners-pcori-transitions-study/. Accessed April 25, 2019.