137 - Standardizing Communication During Patient Transfers from Emergency Department to Inpatient Rehabilitation Facility after Acute Send-Out: A Quality Improvement Project

At an inpatient rehabilitation facility (IRF), medically unstable patients who need a higher level of care are sent to the emergency department (ED). Once evaluated and stabilized they are eligible for transfer back to the IRF where currently an inconsistent patient handoff process was identified. Standardized patient handoffs between care settings are critical to patient safety and align with the National Patient Safety Goals of the Joint Commission. The purpose of this quality improvement (QI) project is to establish a consistent handoff process during this care transition.

Design:

This pilot, single-site, QI project at a large, urban, academic medical center incorporates the following interventions: 1) interdepartmental meetings with nursing, case management, and clinicians, 2) implementation of an Epic Secure Chat messaging group to streamline communication, 3) disseminated educational tipsheet with the standardized communication process, 4) modification of electronic health record ED referral note directing communication through the messaging group, and 5) monthly feedback and audits of outcome data. The primary outcome is change in proportion of eligible patients with completed handoff compared to a baseline period. Secondary outcome includes time to updated code status once arrived at the IRF.

Results:

Baseline data from January 2023 to July 2023 identified 55 patients returning from the ED. Of those, 15 patients were randomly selected for chart review, with documented handoff rates of 0% and 33%, for provider-to-provider and nurse-to-nurse, respectively. This project will pilot with the same ED from September 2024 to December 2024. Final results are expected in January 2025.

Conclusions:

This project aims to improve the completed handoff rate from the ED to IRF to 100% via implementation of a standardized QI protocol. If successful, this pilot will illustrate a low-cost, low-burden solution to optimize patient safety during transfers, which will be scaled to the remaining emergency departments within the health system.