Improving transitions in inpatient and outpatient care using a paper or web-based journal

OBJECTIVE To develop a 'Transitions Journal' for inter-unit and inter-setting communication for improving quality and safety of care and patient satisfaction with timely, reliable and meaningful information for all stakeholders. DESIGN Front-line staff were targeted in a series of four team meetings through which this 'Journal' was developed iteratively; initially as a paper-based and subsequently as an IT-based tool. Goals were to: (1) develop a standardized tool based on SBAR format (Situation, Background, Assessment, Recommendation); (2) facilitate improved communication at the points of care; (3) use a bottom-up approach; (4) create situational awareness and facilitate team formation; and (5) create visual workflow models to help inculcate a culture of safety. SETTING A 183-bed community-hospital and its Primary Care Center, in an urban area in western New York State. PARTICIPANTS Ten nurses and 12 physicians representing both the hospital and primary care center participated voluntarily. MAIN OUTCOME MEASURES (1) Successful development of the 'Transitions Journal'; and (2) identification of its potential uses. RESULTS (1) DEVELOPMENT: the journal was successfully developed in both paper and web-based formats; (2) identification of uses: participants recommended using the tool as a checklist to verify appropriate communication at both the sending and receiving ends; as an audit tool for retrospective review of handoffs; and as a teaching tool. CONCLUSIONS A journal developed by and for front-line staff has the potential to provide opportunities for improvement, instill a systems approach, improve care continuity, improve compliance with safety goals, improve patient and staff satisfaction, reduce duplication and costs, inculcate teamwork, and provide mutual emotional and intellectual support. Further work to evaluate and disseminate this tool is in progress.