1. HAND OFF
COMMUNICATION
Improving patient safety in the Behavioral Health care field
by standardizing communication processes in transitions of
care and when there are risks.
2. A HANDOFF INVOLVES
THETRANSFER OF
PATIENT INFORMATION
AND ESTABLISHING
RESPONSIBILITY
BETWEEN
PROVIDERS AND
DEPARTMENTS
Approaches to
Improvement:
Improve Communication
Improve Discharge
planning &Transitions
between Levels of Care.
Improve Admissions
More efficiency with
Assessments,Treatment
Plans, and overall
patient care
3. Questions to
Consider
Where is the communication failure
happening?
When are we discovering that
information is not being
communicated/transferred?
Is the failure internal or external?
Where is the opportunity for
improvement?
How will we measure the impact of
changes to our communication?
How we will ensure continued
compliance of timely, accurate,
complete, and fully understood hand
off information?
4. Tips for Hand Off Communication
■ Provide handoff in the same order every time;
■ Use verbal, face-to-face communication;
■ Allow two-way exchange;
■ Limit distractions;
■ Allow others to overhear the information;
■ Complete patient assessment prior to handoff;
■ Include the "5 Ps“:
– Patient name, Problem list, Plan of care, Purpose of plan, & Precautions.
5. Tips for Hand Off Communication
■ Use clear language
■ Incorporate effective communication techniques
■ Standardize
■ Create a smooth hand-off between settings
■ Use technology to your advantage
6. Use
Mnemoics:
I PASS the
BATON
Introduction: Introduce -
yourself,Your position,
your patient
Patient: Name,
Identifiers,Age, Sex,
Location
Assessment: Presenting
complaints, vitals, and
symptoms/diagnoses
Situation:Current
status/circumstances,
recent changes, level of
certainty
Safety: Concerns, Labs,
Allergies, Alerts (Falls,
Isolation, Suicide risk)
Background: Previous
episodes, medications,
family hx.
Actions:What actions
were taken or are
required
Timing: Level of
Urgency, prioritization
of actions.
Ownership:Who is
responsible (nurse,
therapist, etc.) including
patient responsibilities.
Next:What needs to
happen next?
Anticipated changes?
Contingency plan?
7. What are the
Barriers
to
Communication
?
Are we communicating
effectively? If not, what
is the most effective
way to share
information?
Is the message clear?
Do I have to search for
the information – or is it
in a place where it is
easily recognizable?
Are we exchanging the
right information?
What type of
information is pertinent
and what is not
important?
8. How do we
improve
Communication
Handoffs?
Coach patients on:
• Medication self-management
• Use of patient-centered language in their chart
• Importance of follow up with physicians and
clinicians
• Knowledge of red flags (signs that the patient’s
condition is worsening and what to do)
Use ‘TEACH BACK’ to assess the
patient’s understanding of discharge
instructions and self care.
Include other providers, family, and
community caregivers as full partners
in assessments and predicting
community needs.
9. Proper Discharge Planning
■ TreatmentTeam participates in discharge planning; Nursing, Case
Managers &Therapists.
■ Discharge planning begins the day the patient arrives.
■ TreatmentTeam meets regularly to discuss progress in the patient’s
discharge planning. Specifically identify readmission risk and factors
those into discharge plan.
■ Provide customized, real time critical info to the next care provider.
– Specifying the process in detail –the content, sequence, timing and
responsible person for each step
– Establishing connections between each step
– Designing a pathway that is simple
– Continuously assessing the outcome and striving to improve
10. Where to
Start?
■ Assess high risk areas
■ Analyze processes associated with
those areas
■ Look for potential areas for failure
■ Seek improvements to reduce failure
likelihood
11. Overview of Handoff Communication
■Make connections with the next level of care or post-treatment supports:
Emphasize the "we" in each person's journey to long-term recovery. Let them know that there are individuals and organizations that can help them to
sustain their recovery, and wherever possible, establish personal connections for internal and external referrals. Establish clear two-way expectations and
communication between levels of care.
■ The guided tour:
Encourage and empower patients to meet with individuals and organizations providing ongoing recovery supports before they leave the facility through
participation in the next level of care or recovery support groups prior to discharge.
■Streamline Paperwork:
Streamline the paperwork process between the referral source and outpatient program to eliminate duplication of effort.
■Overlap Levels of Care:
Overlap outpatient treatment with inpatient treatment from the referring level of care so that patients have the opportunity to experience outpatient
care before being discharged from the referring level of care.
■Blend Levels of Care:
Blend other levels of care with outpatient treatment so that patients can develop therapeutic relationships and familiarity with outpatient patients,
therapists, and locations before moving to outpatient care.
■OrientClients toTreatment:
Provide orientation for both inpatient and outpatient treatment before admission and prior to discharge from a referring level of care. Providing a
patient with Orientation empowers them to know what to expect from the treatment process and their providers.
12. Summary ■ Offer aTour Guide
■ Overlap Levels of Care
■ Blend Levels of Care
■ Include Family/Support Circle in Discharge andAdmission Planning
■ Use Motivational Interviewing
■ UseVideo Conferencing
■ Map Out ContinuingTreatment
■ Orient Clients toTreatment
■ OfferTelephone Support
■ Follow up before and after the patient’s appointment’s post-discharge.
