Don’t drop the baton: A multidisciplinary and interprofessional approach to improving transfer of accountability and information transfer (TOAI).
Notice bibliographique
Résumé
3 Background: Cancer care involves complex transitions across facilities, services and providers. Optimal TOAI is critical to ensuring safe transitions in care. In 2018, the Princess Margaret (PM) Cancer Centre, Division of Medical Oncology and Hematology (DMOH), Quality Program conducted a multi-incident analysis to identify trends in patient transfer-related events (TRE). Priority areas for quality improvement included (1) use of standardized verbal communication, (2) timeliness of handover and (3) documentation. The PM TOAI Working Group (WG) was established to tailor, standardize, implement and evaluate optimal TOAI practices across PM, with the objective of eliminating TRE by 2024. Methods: The WG was established with multi-disciplinary and inter-professional representation across PM services, and met monthly. A needs assessment and environmental scan were completed. Change initiatives were prioritized, and WG focused on developing standards of work (SOW), educational approaches, and evaluation. This work coincided with University Health Network (UHN)’s adoption of I-PASS as the institution’s preferred handover tool, and I-PASS was embedded in all standards created. Change initiatives were: (1) An inter-/intra-facility TOAI SOW was developed (2) A nursing workflow mandating verbal/written handover with patient re-assessment within 1hr of transfer was created (3) Physician (MD) safety huddles with a focus on TOAI in acute oncology clinics and inpatient wards were established, and (4) Evening/weekend inpatient MD handovers were restructured and standardized. From Oct 2021 to Dec 2023, the TOAI WG completed eight cycles of PDSA change initiatives. Pre- and post-implementation surveys were conducted to identify and address barriers. Audits were used to evaluate consistency & quality of inpatient handover rounds. Results: PM reported a serious safety event rate per 10 000 adjusted patient days (SSER) of 1.24(2016); this has been reduced to 0.29 (2024). From 2013-2018, TRE occurred at PM with intervals ranging from 1 to 38 days. In the latter half of 2018, since establishing the TOAI WG, there was a gap of 123 days before the most recent event occurred. The current days between events is > 800 as of May 2024. Conclusions: Systematic implementation of TOAI initiatives at PM has improved the safety and effectiveness of patient care transitions through the adoption of tailored, standardized communication tools and targeted education, which has facilitated a sustained culture shift toward TOAI. These initiatives have reduced SSEs and fostered better communication and collaboration amongst healthcare providers. The sustained improvements highlight the significance of broad engagement of front-line staff and continuous evaluation in ensuring safe, high quality healthcare practices.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,004 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».