Intrahospital TOA: Safe transitions for a safe system

By Emily Holton

RNs Carl Leushuis and Suzanne Scotland double check the name on a patient’s wristband before he goes to Medical Imaging. (Photo by Yuri Markarov)

A new e-ticket is helping to ensure that when inpatients move between non-critical patient care areas, their safety information is front-and-centre when they arrive.

If the patient is at risk of falling, needs special equipment or extra infection-control precautions, this information is automatically pulled from his or her electronic medical record and highlighted in the e-ticket for transfer.

“Before now, we would call the receiving unit or area to make sure they had the details about the patient that we thought were of note,” said Carl Leushuis, a registered nurse and best practice champion in Hematology/Oncology.

“However, working on the project, it became clear that the information we were choosing to highlight for each patient was very subjective. What we thought was important for the Medical Imaging staff to know may not have been what they actually needed to do their work and keep the patient safe in their context.”

Leushuis co-led a pilot of the e-ticket and associated decision-making guidelines in Hematology/Oncology, along with Suzanne Scotland, a registered nurse and best practice champion. Nephrology, Patient Transport and Medical Imaging also piloted the tools. The project contributed to the hospital’s implementation of the Registered Nurses’ Association of Ontario Best Practice Guideline to promote safe and effective care transitions and built on the successful work to implement hospital-wide, shift-to-shift transfer of accountability.

“The e-ticket doesn’t replace our telephone communication, but it guides the questions the receiving unit or area can ask,” said Scotland. “They can see all the pertinent information right away, and then use the phone call to verify it with us. I feel that this is the key to implementing a BPG. For it to be successful, you have to tie it into the work you already do. We weren’t reinventing the wheel, we were articulating, standardizing and improving the way we already provide care.”

The pilot was part of an ambitious research, education and quality improvement initiative to develop and implement the e-ticket and associated decision-making guidelines to ensure safe transfer of non-critical patients. The project required education, engagement and practice change among front-line staff across the hospital: registered nurses as well as patient-transport assistants and health disciplines, clerical and medical imaging staff. A hospital-wide research project is evaluating staff perceptions of the tool and guidelines.

“There are always new initiatives – it’s a challenge to keep up with them as a staff member,” said Scotland. “But we’ve generated a lot of buy-in through our education and advocacy, so it feels like we’re set up for success.”

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 29 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.