Project BOOST seeks to improve care transitions
Project BOOST seeks to improve care transitions
Approach was to create a national consensus
With the recognition by hospitalists that improvements needed to be made in transitions in care, primarily focusing on the discharge process to prevent readmissions, the Society of Hospital Medicine has set out to make those improvements.
The society is attempting to build a national consensus for best practices through what it calls Project BOOST (Better Outcomes for Older adults through Safe Transitions).
"This [project] was an outgrowth of the efforts by the Society of Hospital Medicine to improve care for geriatric patients in recognition that because there is this discontinuity now between the hospital and the doctor and the outpatient physician, we needed to optimize that transition," says Mark V. Williams, MD, FACP, FHM, principal investigator on Project BOOST.
Williams is professor and chief of the division of hospital medicine at Northwestern University Feinberg School of Medicine. He is also a past president of the society and editor-in-chief of the Journal of Hospital Medicine.
He says that the society was "fortunate and grateful" to receive a $1.3 million grant from the John A. Hartford Foundation "to develop a toolkit that hospitals could use to optimize the discharge process."
The goals of Project BOOST are to:
— reduce 30-day readmission rates for general medicine patients (with particular focus on older adults;
— improve facility patient satisfaction scores;
— improve the institutions H-CAHPS scores related to discharge;
— improve flow of information between hospital and outpatient physicians;
— ensure high-risk patients are identified and specific interventions are offered to mitigate their risk;
— improve patient and family education practices to encourage use of the teach-back process around risk-specific issues.
Project BOOST's advisory board includes representatives from the Agency for Healthcare Research and Quality (AHRQ), The Joint Commission, the Centers for Medicare & Medicaid Services, Blue Cross and Blue Shield Association, pharmacy, nursing, geriatricians, patient advocates, and others.
Williams, whose original research work was in health literacy, was once funded by the AHRQ to develop a toolkit for the discharge process called the Patient Safe Discharge. Those materials are on the web site for Project BOOST, as is the information from Re-engineering Discharge (RED) completed at Boston University. Also incorporated is material from SafeSteps at Johns Hopkins in Baltimore.
"Our goal is to come up with the ideal toolkit and then be flexible as it is implemented at institutions," Williams tells Medical Ethics Advisor.
Last September, six hospital were selected to participate in Project BOOST's pilot mentoring program, which is called cohort one. Cohort two, which includes 24 hospitals, began utilizing the BOOST toolkit in March.
The initial program begins with a day-long training session, and it also includes year-long coaching and mentoring.
The resources include everything from data collection tool to project management tools and a review of key literature.
Piedmont Hospital a BOOST participant
Piedmont Healthcare in Atlanta is a four-hospital system, of which Piedmont Hospital is the largest, with about 500 beds.
Matthew Schreiber, MD, interim CMO and medical director, Piedmont Hospital Physicians LLC, is orchestrating the implementation of Project BOOST at that hospital, which has been integrated and incorporated into process re-engineering that was already under way at the hospital.
It's that combination of attention to underlying processes — along with the implementation of Project BOOST — that is leading to success.
For starters, Schreiber commandeered one of the floors of the hospital and designated that 20-bed nursing unit exclusively for patients who are attended by hospitalists at Piedmont Hospital.
"I approached the administration and co-opted 6 North . . . and said, In this unit, I want to tinker with things, and the first, most important thing that's going to happen is we're going to assign our patients based on attending physician — that is, the hospitalist — instead of by disease state, which is the traditional way of assigning patients to a nursing unit," Schreiber tells MEA.
Schreiber says the notion of a "geographically designated ward" is "pretty popular right now." It allows physicians to cut down on time transitioning between patients, as they normally might have to go up and down hospital floors several times a day. With all of their patients in one ward, the hospitalist can cut down on traffic time, and that amounted to about an hour a day, according to Schreiber.
In addition to a day of training, Project BOOST has given Schreiber and his team not only a tool kit of patient care and discharge forms that "had been vetted by some of the nation's experts" in the field — that are "intelligently designed" — but it has given his team access to Williams, an authority on discharge processes, as a mentor and guide while the hospital implements the program.
"The thing that's hard about doing [Project] BOOST is the underlying process," Schreiber says:
- Who is responsible for handing out the forms?
- Who is responsible for making sure the information gets ticked off?
- Who is responsible for responding if by completing a form someone determines that a patient is at risk?
- Whose job is it to then say, 'Aha, this patient is at risk, and do some type of intervention?'"
"Somebody has to care what the content [of the forms] is, and then somebody has to change their behavior based on the content that you've gotten from that form," Schreiber notes. "That's the process piece; you can't use BOOST without refining these tasks."
Sources
- Matthew Schreiber, MD, Interim CMO, Medical Director, Piedmont Hospitalist Physicans, LLC, Piedmont Hospital, Atlanta, GA. E-mail: [email protected].
- Mark V. Williams, MD, FACP, FHM, Professor and Chief, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago. E-mail: [email protected].
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