“Warm handoffs” can reduce hospitals’ readmission rates
Collect data discharges, handoffs
Newton-Wellesley Hospital in Newton, MA, improved its readmission rates through a quality improvement process that included measurements of “warm handoff” rates.
As a result, readmission rates fell and patient experience rates improved, says Bert Thurlo-Walsh, RN, MM, CPHQ, vice president of quality and patient safety at Newton-Wellesley Hospital. Thurlo-Walsh recently received the Rising Quality Star Award from the National Association for Healthcare Quality (NAHQ).
“We’ve been collecting warm handoff rates, including how many patients are discharged, whether the warm handoff was conducted and documented, the rate of completion by unit, and an overall aggregate,” Thurlo-Walsh says.
“We look at the overall readmission rate in 30 days for all causes, all payers, and we don’t drill down into individual areas,” he adds.
Unit-by-unit data is more challenging to measure because patients can be transferred from one unit to another, and it’s difficult to track them, he explains.
So the quality department looks at the overall readmission rate and disease-specific rates, such as rates for heart disease diagnoses, pneumonia, strokes, and chronic obstructive pulmonary disease (COPD), he says.
“If patients with those conditions are readmitted for any other reason, we look at that, as well,” Thurlo-Walsh says.
The following are some of the steps the quality department took to achieve positive outcomes:
• Warm handoff. “Our biggest focus has been nurse to nurse,” Thurlo-Walsh says.
Communication needs to be fluid between the inpatient care nurse at the hospital and the skilled nursing facility (SNF) nurse.
The hospital nurse should make sure the SNF nurse receives the patient’s paperwork before the handoff occurs. And they should speak, discussing interventions done in the hospital, antibiotics or other medications, and discharge instructions for the patient and family, he explains.
The hospital’s discharge process should include the teach-back method to improve patients’ understanding of what needs to be done, he adds.
“All of that information goes to the next provider of care,” Thurlo-Walsh says.
• Making discharge phone calls. “The discharge phone calls are when patients are discharged to their home with or without services,” he says. “They receive a discharge phone call from one of our staff nurses within 24 to 48 hours with specific questions around their care and transition to home.”
Nurses also ask about opportunities for improvement: “How can we do better on our end, and would you like to recognize anyone for exceptional care?”
That last question is key, Thurlo-Walsh says.
“We believe in recognition and always want to do better,” he says. “We have a great service excellence program and want to recognize our staff that’ve done a good job because recognizing staff is key to keeping them happy.”
• Improve communication. “In relation to HCAHPS, nurse communication is the biggest driver of almost every other domain except physician communication and quality,” Thurlo-Walsh says. “If you do well with that, then almost all fall into place; in our service excellence program we link the two together now.”
For instance, if patient surveys demonstrate quality nurse communication, then patients also rate pain management and medication communication higher, he adds.
“We’ve run data on whether or not a patient received a post-discharge phone call, and we looked at the difference from overall domain scoring,” Thurlo-Walsh says. “In all domains, it was consistently higher if they received a call versus if they didn’t, and we follow that data ongoing.”
Newton-Wellesley Hospital in Newton, MA, improved its readmission rates through a quality improvement process that included measurements of “warm handoff” rates.
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