Teamwork Improves Transitioning Blood, Marrow Transplant Patients to Outpatient Unit

Nursing staff satisfaction improved in transition of care for patients from the inpatient to the outpatient blood and marrow transplant units.
Nursing staff satisfaction improved in transition of care for patients from the inpatient to the outpatient blood and marrow transplant units.

ORLANDO, FL—Nursing staff satisfaction improved when the transition of care for patients from the inpatient to the outpatient blood and marrow transplant (BMT) units included a standardized approach using electronic communication in SBAR—Situation, Background, Assessment, Recommendation—format, according to a study presented at the ONS 40th Annual Congress.

Safe patient handoffs are a national patient safety goal. “Poor transitions are noted in the literature to be a key source of communication failures, adverse events, and readmissions,” said Gina Quinlan,  MSN, RN, OCN®, and colleagues at UPMC Shadyside, Pittsburgh, Pennsylvania.

What is needed to assure safe transition from one health care setting to another is a strong foundation that includes developing a standard process that can improve communication, reduce errors and readmissions, and strengthen the care continuum, while promoting patient satisfaction across the care setting.

With this is mind, the UPMC Shadyside nurses on the inpatient and outpatient BMT units identified a gap in transition of care from inpatient to outpatient.

“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,” explained Sara Orndoff, MSN, RN, OCN®, also of UPMC Shadyside. In a survey of outpatient providers, approximately 30% of respondents reported they had not received a report when a patient is discharged from inpatient care.

After surveying and interviewing nurses in both settings regarding the current method of handoff report for discharged patients and finding communication to be both insufficient and irrelevant, a workgroup was formed with leadership and nurses from both units with the goal of improving transitions.

This led to the decision to move to the SBAR format, which collects relevant information needed by the clinic staff to develop the plan of care for the outpatient setting, as well as allows direct communication with outpatient clinic care providers.

Included is information about immunosuppression, homecare orders for labs and infusions, and an area to convey any psychosocial concerns.

By providing critical data to the outpatient area, the handoff has improved. More than 95% of nurses who reported using the SBAR acknowledged receiving patients' discharge reports and found them useful.

Use of the SBAR format has been expanded to include other outpatient oncology clinics within the health system and two more inpatient units, and has also highlighted care transition challenges from outpatient to inpatient.

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