Final Project Presentation - Very Critical (Please read All instructions Attachment)
jhayes
McLarenNorthernMichiganTransferPeerReviewProcessTeam-White.pptxTransfer Peer Review Process Development
Kathleen St. Pierre, RN, BSN
MSN Candidate
Walden University
Capstone Synthesis Practicum
NURS-6600-3
November 11, 2017
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Project Summary
Rural Regional Referral Center serving 22 counties in Northern Michigan
One third of admissions are transfers from critical access or community hospitals who lack capability to provide higher level care (Dunne, 2001).
No standardized means currently to review transfers
Background
As a rural regional referral center in northern Michigan currently seeking Level 2 trauma designation and serving 22 rural counties, one third of our unplanned admissions are transfers from other facilities. These referral facilities are primarily critical access and/or community hospitals who lack the capability to provide higher level care (Dunne, 2001). There was not a standardized means to review these transfers for appropriateness; courteous and respectful provider interactions; accuracy of initial patient assessment and early interventions; length of time transfer coordination requires; discussions of the futility of care; and delays in non-acceptance of higher acuity patients.
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Project Goals and Objectives
Development of a standardized, consistent peer review process of a patient transfer or patient declination at the request of any participant in the process.
Overarching Project Goal:
The overarching goal of this project is the development of a standardized, consistent peer review process of a patient transfer or patient declination at the request of any participant in the process.
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Objectives:
A Transfer Peer Review Process will be developed.
The Transfer Peer Review Process will be reviewed and approved by the Senior Executive Team (SET).
The transfer review team will be identified and invited to participate.
Organizational and referral transfer participants will be educated to the Transfer Peer Review Request Process.
SET will discuss purchasing a program to record transfer calls.
Eastes (2010) indicated these five objectives contain the elements of a successful peer review program (Eastes, 2010).
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Demonstrated Need
Provide incidental information
External stakeholder dissatisfaction
Disrespectful interactions with accepting providers
Length of time required for transfer coordination
Delayed acceptance or declination of high acuity patients
Request for additional testing prior to transfer
Declination due to bed unavailability
Discussions regarding futility of care
Outreach Coordinators
Our outreach coordinators provided incidental information regarding dissatisfaction with the transfer process; the interactions with the providers; the length of time transfer coordination requires; discussions of the futility of care; and delays in non-acceptance of higher acuity patients (Broman, Phillips, Ehrenfeld, Patel, Guillamondegui, Sharp, & ... Holzman, 2017).
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Demonstrated Need
Provide incidental Information
Internal stakeholder dissatisfaction
Disrespectful interactions with referring providers
Length of time required for transfer coordination
Transportation arrangements delay patient arrival
Patient acuity higher/lower than discussed
Patient not stabilized prior to transfer
Deterioration of patient during transfer
Patient diverted to ED
House Supervisors
House Supervisors provided incidental information regarding internal stakeholder dissatisfaction with unspecific transfers. Our unit based team leaders provided instances where the arriving patients’ acuity was either higher or lower than expected based on the report received.
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Literature Review
Professionals are responsible to review the processes surrounding and the outcomes of care (AACN,2012).
Self-regulation and the promotion of quality care can be achieved through reviewing events against identified standards and evidence-based care (Roberts & Nones-Cronin, 2017).
Non-punitive review of processes and interactions ensures safety is maintained and prevents reoccurrences (Branowicki et al, 2011).
Peer review processes support other organizational quality and safety initiatives (Gandhi et al, 2017).
Nurse administrators’ scope of assessment includes the collection and analysis of trended data which can be utilized to improve care processes or outcomes for patients (ANA, 2009).
Nurse leaders support professional development and learning through non-punitive peer review processes (Boehm & Bonnel, 2010).
Peer review can support organizational standards, identify specific practitioner issues, and strengthen interpersonal relationships (Bergum, 2017).
The American Association of Critical Care Nurses (AACN) (2012) indicated professionals are responsible to review the processes surrounding and the outcomes of care. Roberts and Nones-Cronin (2017) indicated self-regulation and the promotion of quality care can be achieved through reviewing events against identified standards and evidence-based care. Non-punitive review of processes and interactions ensures safety is maintained and prevents reoccurrences (Branowicki, Driscoll, Hickey, Renaud, & Sporing, 2011). Peer review processes support other organizational quality and safety initiatives (Gandhi, Louis, Wilson, & Clark, 2017).
The American Nurse Association (ANA) (2009) identified the nurse administrators’ scope of assessment includes the collection and analysis of trended data which can be utilized to improve care processes or outcomes for patients. Nurse leaders then can support professional development and learning through non-punitive peer review processes (Boehm & Bonnel, 2010).
Bergum, Canaan, Delemos, Gall, McCracken, Rowen, Salvemini and Wiens (2017) indicated peer review can support organizational standards, identify specific practitioner issues, and strengthen interpersonal relationships. The development and implementation of a Transfer Peer Review Process would provide opportunities for quality outcomes for our referred patients and relationship building within our service area.
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Methodology:
Reviewed and observed current organizational review processes including nursing peer review, medical peer review, and trauma peer review.
Interviews, observations, and focus groups with internal/external stakeholders.
Input from internal/external stakeholders was utilized to develop the review tool.
Senior Executive Team (SET) reviewed and approved the composition of the review team and the tool utilized to conduct the review.
Education of the transfer review process provided to internal/external stakeholders.
SET discussed proposal to record all transfer calls: awaiting funding.
Summary
These review processes each have a means of requesting the review, a data collection tool, and a team who meets to determine next steps following the review.
Referring providers, accepting providers, house supervisors, and unit based team leaders were included in the fact-finding process.
Input from these groups was utilized to develop the review tool; the transfer review team will be comprised from the same groups.
The ability to record the transfer calls between the referring provider, the accepting provider(s), and the house supervisor has been discussed in the recent past. A change in medical leadership at our facility has placed a hold on the implementation of recorded transfer calls. Both referring and accepting providers have voiced an interest in further investigation of this capability. When our organization transfers a patient to a higher level of care the call is recorded at the receiving facility; this recording is utilized when the receiving facility provided feedback regarding our transferred patient. SET approved purchasing recording capability; the purchase and implementation of recording capability will extend beyond the parameters of the practicum project. Obtaining SET approval for the review process, team selection, and recording capability was achieved through an evidence based presentation to SET.
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Project Findings
Positive feedback from all stakeholders
Outreach Coordinators and external stakeholders appreciative
Internal stakeholders desired feedback process for referring organizations
Forms developed and approved by marketing
Recommendations from Senior Executive Team incorporated into team composition
Electronic call recording system awaiting capital budget process approval
Internal Stakeholder, External Stakeholder, and Senior Executive Team Engagement
Positive feedback was received from all internal and external stakeholders. The Outreach Coordinators were the sounding board for our external stakeholders and shared their concerns. The concerns, however, were generalized, did not contain patient specific identifiers, and were challenging to provide specific feedback. The internal house supervisors, unit based team leaders, and accepting providers managed the patients. Their concerns were voiced in other venues and again did not provide specific patient identifiers. The lack of a specific process only allowed for generalities.
Samples of the developed forms are in the next few slides; input was provided from external and internal stakeholders during development. Marketing reviewed the Transfer Request Form and provided input as it will be provided to external stakeholders
The Senior Executive Team recommended adding an Emergency Department Provider to the Transfer process Review Team.
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Transfer Peer Review Team
Manager Staffing/Supervision
Manager Trauma Program
Manager Emergency Department
Manager Performance Improvement
Outreach Coordinator
Emergency Department Provider
Hospitalist
Intensivist/Specialist
Inpatient Manager ICU/CVU
Senior Executive Team Sponsor
Composition:
Team composition was based on internal stakeholder recommendations. The Senior Executive Team recommended adding an Emergency Department Provider. There was discussion at the Senior Executive Team meeting and with the Outreach Coordinators how we could incorporate a referring provider on the team. It was decided to allow the recommended team to discuss this option further.
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Conclusions
Well accepted by internal and external stakeholders
Expect positive patient impact
Anticipate improved quality of care
Impact to Management/Leadership specialty and organization
Improved stakeholder satisfaction
Possible increased market share of transfer population
Next Steps
Next Steps
Survey internal and external stakeholders regarding satisfaction with transfer process
Improve transfer process based on information received
Transfer Peer Review Process
The transfer peer review process has been well accepted by our internal and external stakeholders. The impact to our patients should be positive and improve the quality of care our patients receive.
The impact within the management/leadership specialty and within the practicum organization is improved stakeholder satisfaction which could be correlated over time to a larger market share of the transfer population.
Recommendations and next steps: survey external and internal stakeholders regarding satisfaction with the transfer process and utilize that information to streamline access for our transfer patients.
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Transfer Review Request Form
This form would gather the necessary data necessary to begin the review process. Actual use of the form will not be required; the information could be included in an email, phone conversation, or directly with the Outreach Coordinators. This should decrease the incidental information received without enough specific patient information to complete a review.
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Transfer Peer Review Worksheet
The next four slides include portions of the peer protected review worksheet. All areas may not be pertinent in all cases. The Transfer Peer Review team may also note areas where expectations were exceeded.
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Worksheet part 2
The patient outcomes and effect on care will allow stratification of severity based on potential impact to the involved patient.
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Worksheet part 3
The final page will document the next step in the review process and includes a reminder to positively reinforce behaviors and interactions that exceeded expectations. .
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Confidentiality Agreement
The work of the Transfer Peer Review team is confidential. All participants and guests will be required to sign a confidentiality agreement annually.
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Confidentiality Agreement part 2
Ensuring procedural confidentiality is maintained ensures the results of the proceedings are non-disclosable.
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Summary
Pre-implementation less than 0.5% of transfers quality reviewed
Need demonstrated by Outreach Coordinators and House Supervisors
Literature review supports peer review process
Interviews, observations, and focus groups utilized to gather data
Senior Executive Team approved implementation of Transfer Peer Review Process, team composition, and forms
Awaiting capital budget process to purchase electronic recording system
Next steps: survey internal and external stakeholders for transfer call process satisfaction and potential improvements
Transfer Peer Review
As stated earlier, less the 0.5% of transfer were reviewed from a quality perspective. Incidental information regarding stakeholder satisfaction was provided by Outreach Coordinators and House Supervisors. The literature review supports the implementation of a peer review process to ensure quality is achieved. Pre-implementation data was gathered through interviews, observations, and focus groups. Post-implementation data will be gathered in the same manner.
Senior executive team approval received for implementation and forms developed. They also suggested the addition of the ED provider to the team. We are waiting for the capital budget process completion prior to purchasing the electronic recording system.
Next steps include surveying internal and external stakeholders satisfaction with the current transfer process and possible process improvements.
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References
American Association of Critical Care Nurses (AACN). (2012). AACN standards for establishing and sustaining healthy work environments: A journey to excellence. American Journal of Critical Care, 14(3), 187-198.
American Nurses Association (2009). Nursing administration: scope and standards of practice. Silver Spring, Maryland: Nursebooks.org.
Bergum, S. K., Canaan, T., Delemos, C., Gall, E. F., McCracken, B., Rowen, D., & ... Wiens, K. (2017). Implementation and evaluation of a peer review process for advanced practice nurses in a university hospital setting. Journal Of The American Association Of Nurse Practitioners, 29(7), 369-374. doi:10.1002/2327-6924.12471
Boehm, H., & Bonnel, W. (2010). The use of peer review in nursing education and clinical practice. Journal For Nurses In Staff Development, 26(3), 108-115. doi:10.1097/NND.0b013e3181993aa4
Branowicki, P., Driscoll, M., Hickey, P., Renaud, K., & Sporing, E. (2011). Exemplary Professional Practice Through Nurse Peer Review. Journal Of Pediatric Nursing, 26(2), 128-136. doi:10.1016/j.pedn.2010.12.009
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References (cont.)
Broman, K. K., Phillips, S. E., Ehrenfeld, J. M., Patel, M. B., Guillamondegui, O. M., Sharp, K. W., & ... Holzman, M. D. (2017). Identifying Futile Interfacility Surgical Transfers. American Surgeon, 83(8), 866-870.
Dunne, K. (2001). EMTALA: standard for patient transfer based on hospital's procedure. Journal of Law, Medicine & Ethics, 29(2), 236-237
Eastes, L. (2010). Best practice: Oregon's model for regional trauma system peer review. Journal Of Trauma Nursing, 17(3), 148-152. doi:10.1097/JTN.0b013e3181f52135
Roberts, H., & Nones-Cronin, S. (2017). A Descriptive Study of Nursing Peer-Review Programs in US Magnet® Hospitals. Journal Of Nursing Administration, 47(4), 226-231. doi:10.1097/NNA.0000000000000469
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Questions?
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