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Transitions of Care Policy

I. Purpose of Policy

To establish training and operational standards intended to ensure the quality and safety of patient care. Transitions of care between internal providers are vulnerable to error and a clear delineation of training program and provider responsibilities surrounding this activity promote and support our institutional culture of safety.

II. Policy Scope

This policy applies to all residency and fellowship programs with reference to transitions of care within the institution.

III. Definitions

Resident: Any physician in an accredited graduate medical education program, including interns, residents, and fellows.

Transitions of care: The transition of care referred to in this policy is the hand-over of responsibility for patient care from one provider to another, most commonly at the time of check-out to on-call teams. However, the same principles apply to other transitional settings, including transfers between one clinical care setting to another or the scheduled change of providers (e.g. end of month team switches).

Hand-over: Transfer of essential information and the responsibility for care of the patient from one health care provider to another.

Patient safety practices: Habits and routines that reduce the risk of adverse events related to exposure to medical care across a range of diagnoses or conditions.

IV. Policy Statement

  • Key patient safety practices critical to the effective transition of care:
    • Interruptions must be limited
    • Current, minimum content must be conveyed
    • The opportunity to ask and respond to questions must be provided
    • Hand-over documents must be HIPAA compliant

  • Minimize Interruptions
    • Participate in hand-off communication only when both parties can focus attention on the patientspecific information (i.e. quiet space).

  • Current, Minimum Content - Hand-over communication must include the following information:
    • Patient name, location and a second chart-based identifier (e.g. MRN or DOB)
    • Identification of primary team or attending physician
    • Pertinent medical history including:
      • Diagnosis
      • Current condition
      • Pertinent labs
      • DNR status

  • Anticipated changes in condition or treatment - Suggested actions to take in the event of a change in the clinical condition
    • Any elements that the receiving provider must perform (i.e., a “to-do” list)

  • Opportunity to Ask & Respond to Questions - Allow adequate time for hand-over communication and maximize opportunities for face-to-face or verbal handoffs:
    • Face-to-face hand-overs should occur if at all possible
    • If not possible, telephone verbal hand-overs may occur
    • In either case a recorded hand-over document (written or electronic) must be available to the receiving provider
    • The hand-over must include an opportunity for the participants to ask and respond to questions

  • HIPAA Compliant Hand-Over Documents
    • All written or electronic hand-over documents must be HIPAA and D-H policy compliant.
    • Programs are encouraged to utilize the hand-over report templates in our Electronic Health Record as the standard framework for patient hand-overs.

  • The Residency and Fellowship Program Directors must:
    • Ensure and monitor effective, structured hand-over processes to facilitate both continuity of care and patient safety. (2015 ACGME Common Program Requirements VI.B.2)
    • Ensure that residents are competent in communicating with team members in the hand-over process. (2015 ACGME Common Program Requirements VI.B.3)
    • Design clinical assignments to minimize the number of transitions in patient care. (2015 ACGME Common Program Requirements VI.B.1)

D-H Policy ID: 11280