Improving Transitions from the Inpatient to Outpatient Setting in BMT Patients

Topic Significance & Study Purpose/Background/Rationale 

Safe patient handoffs are a national patient safety goal.  The inpatient and outpatient Blood and Marrow Transplant (BMT) units identified a gap in transition of care from in to out patient.  Information was being conveyed by multiple members of the care team to the outpatient nurses, however, no communication was occurring on a nurse to nurse level.  Information was not conveyed consistently to the outpatient clinic.  Poor transitions are noted in the literature to be a key source of communication failures, adverse events and readmissions.  Literature also discusses the need for establishing a foundation to assure safe transition from one health care setting to another.  Development of a standard process can reduce errors, readmissions and also promote patient satisfaction across the care setting. 

Methods, Intervention, & Analysis

Nurses in both setting were surveyed and interviewed regarding the current method of handoff report for discharged patients.  A workgroup was formed with leadership from the inpatient and outpatient setting along with nurses from both outpatient and inpatient with the goal to improve transitions by developing a standard tool.

Findings & Interpretation 

The current process was found to be both insufficient and irrelevant.  It was decided to move to a standardized approach using electronic communication in SBAR format, which includes relevant information needed by the clinic staff to develop the plan of care for the outpatient setting.   

Discussion & Implications 

The SBAR format allows direct communication with outpatient clinic care providers.  Pertinent information includes immunosuppression information, homecare orders for labs and infusions, and an area to convey psychosocial concerns.  This process has improved the handoff by providing critical information to the outpatient area.  Additionally, this method of communicating discharge information was spread to other outpatient oncology clinics within the health system as well as 2 more inpatient units.  The new process has also highlighted care transition challenges from outpatient to inpatient.  Evaluating patient education across the BMT program and assuring congruency across the continuum of care is also a next step.