by C Coffey · 2013 · Cited by 1 — Website: hospitalmedicine/Boost The Project BOOST® logo is a federally registered trademark of the Society of Family_Engagement_2013.pdf).
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Copyright ©2013 by Society of Hospital Medicine. All rights reserved. No part of this publication may be reproduced, stored in retrieval system,or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission.Unlawful scanning, uploading and distribution of this book via the Internet or via any other means without the permission of Society of Hospital Medicine may be punishable by law. For more information or to obtain additional copies contact SHM at:Phone: 800-843-3360 Email: BOOST@hospitalmedicine.org Website: www.hospitalmedicine.org/B OOST
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The Project BOOST® Team (Second Edition)Mark V. Williams, MD, FACP, MHMPrincipal Investigator, Project BOOST Professor of MedicineDirector, Center for Health Services Research University of KentuckyLexington, KYTina Budnitz, MPHBOOST Project ArchitectSociety of Hospital MedicineAtlanta, GAChase Coffey, MD, MSSenior Staff HospitalistAssociate Medical Director forQuality and Performance ExcellenceHenry Ford Health System Detroit, MIJeffrey L. Greenwald, MD, SFHMCo-Investigator Inpatient Clinician Educator Service Massachusetts General HospitalBoston, MAEric Howell, MD, SFHMCo-InvestigatorDirector of the Hospitalist Division Director, Hospital Care Johns Hopkins Bayview Medical CenterBaltimore, MDGreg Maynard, MD, FHMCo-InvestigatorChief Medical Of˜cer, Society of Hospital Medicine Clinical Professor of Medicine Chief, Division of Hospital MedicineUCSD Medical CenterSan Diego, CALauren O™SullivanProject BOOST National ManagerSociety of Hospital MedicinePhiladelphia, PA Kimberly SchonbergerMarketing Project Manager Society of Hospital MedicinePhiladelphia, PA Additional Contributors:Jing Li, MD, MSResearch Program DirectorProject Director, BOOST Š Illinois Division of Hospital MedicineNorthwestern University Feinberg School of MedicineJessica Phillips, MSResearch CoordinatorDivision of Hospital MedicineNorthwestern University Feinberg School of Medicine
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BOOST® Mentors (Past and Present)Mark V. Williams, MD, FACP, MHMProfessor of Medicine Director, Center for Health Services Research University of KentuckyPrincipal Investigator, Project BOOST Past-President, Society of Hospital MedicineFounding Editor, Journal of Hospital Medicine Jeffrey Greenwald, MD, SFHMAssociate Professor, Harvard Medical School Inpatient Clinician Educator Service, Massachusetts General HospitalCo-Investigator, Project BOOST Chase Coffey, MD, MSSenior Staff HospitalistDivision of Hospital MedicineHenry Ford Health System Quality AssociateHenry Ford West Bloom˜eld Hospital Nasim Afsar-manesh, MDAssistant Clinical Professor Internal Medicine & Neurosurgery Associate Medical Director Quality & Safety UCLA Medical Center Director Hospital Medicine & Neurosurgical Clinical Quality Programs Ronald Reagan UCLA Medical CenterAziz Ansari, DO, FHMAssociate Director, Division of Hospital Medicine Medical Director, Loyola Home Care and Hospice Assistant Professor of MedicineLoyola University Stritch School of MedicineNeal Axon, MDAssistant ProfessorMedical University of South CarolinaRichard B. Balaban, MDAssistant Professor of Medicine, Harvard Medical School Associate Chief of Hospital MedicineCambridge Health AllianceRebecca Daniels, MD, FACPAssociate Program Director, Internal Medicine Director, Clinical Research, Internal Medicine St. Joseph Mercy Health SystemDaniel D. Dressler, MD, MSc, FHMDirector of Education, Section of Hospital MedicineAssociate Program Director, J Willis Hurst Internal Medicine ResidencyDirector, Internal Medicine Teaching Services, Emory University Hospital Vikram K. Devisetty, MD, MBA, MPHAssistant Professor of Medicine, Division of Hospital MedicineNorthwestern University Feinberg School of MedicineLuke Hansen, MD, MHSLead Analyst, Project BOOST Assistant Professor of Medicine Northwestern University Feinberg School of MedicineKeiki Hinami, MD, MSAssistant Professor of Medicine, Division of Hospital Medicine Northwestern University Feinberg School of MedicineLakshmi Halasyamani, MD, FHM Vice President for Quality and Systems ImprovementSaint Joseph Mercy Health System Co-Investigator, Project BOOST Eric Howell, MD, SFHMAssociate Professor of Medicine Director, Johns Hopkins Bayview Hospitalist Division Johns Hopkins University, School of Medicine President, Society of Hospital Medicine Co-Investigator, Project BOOST
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Executive Summary The Society of Hospital Medicine (SHM) enthusiastically introduces the Second Edition of the Project BOOST ® Implementation Guide . Since its launch in 2008, Project BOOST (Better Outcomes by Optimizing Safe Transitions) has helped more than 180 hospitals and health systems improve their care transition processes. SHM is the ˜rst national medical association to be recognized by the National Quality Forum and The Joint Commission with the John M. Eisenberg Patient Safety and Quality Award for Innovation in Patient Safety. The award acknowledges SHM for its innovative mentored implementation model, which has been utilized in more than 300 hospitals, touching the lives of tens of thousands of patients across the country. Project BOOST Š SHM™s signature mentored program Š serves as a national model for improving the quality of care and reducing hospital readmissions. Project BOOST has also been recognized by the Centers for Medicare & Medicaid Innovation (CMMI) as an evidence- based approach to reducing readmissions. In addition to achieving reductions in unnecessary readmissions, some sites report increased patient satisfaction and improved length of stay in the hospital. Currently, more than 180 hospitals participate in Project BOOST, over 1,000 health care professionals participate on its active Listserv and more than 5,000 people have downloaded the original Project BOOST Implementation Guide and Toolkit . This Second Edition incorporates the many lessons learned through BOOST mentor interactions with sites throughout the United States and Canada. For any site considering adoption of Project BOOST, please note the following: more than just the discharge process, and consequently it provides bene˜ts beyond reducing unnecessary readmissions. Project BOOST sites develop improved interprofessional work environments and communication, proactively identify and mitigate patients™ risk factors for poor transitions from the hospital, and enhance patient and caregiver satisfaction through more effective interactions. BOOST tools and concepts to meet its needs, priorities, resources and culture. critical, as is engagement with front-line staff (e.g., nurses, case managers, social workers, pharmacists and physicians), both in the hospital and post-acute care setting. successes. These individuals can offer important guidance on how best to navigate the political landscapes that major projects such as these may encounter. The Project BOOST online community is a tremendous resource where organizations can share stories, lessons learned, tools and insights.PROJECT BOOST® IMPLEMENTATION GUIDEi
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How to Use the Implementation GuideSHM designed the Implementation Guide to function as a workbook. As you move through the material, you will be asked to complete to improve care transitions at your organization, and why does your current situation exist? Next, your team will develop a shared mental model on your objectives for this important work. Finally, your team will strategically implement the BOOST tools to help you achieve your objectives. While this recipe for success may sound simple, it is hard work Š and your team will face obstacles along the way. To help you overcome these obstacles we have also redesigned the Project BOOST website so that it is more user-friendly and aligned with the new Implementation Guide in order to provide additional support and resources to BOOST teams. Institutions of˜cially enrolled in the Project BOOST Mentored Implementation Program can take advantage of additional online resources, as well as a growing online BOOST community. This group regularly discusses how to improve the care transition process and shares resources with one another on how to expedite implementation and expand on the BOOST interventions. In addition, BOOST-mentored sites receive one-on-one mentorship from a physician expert in care transitions and change management. This mentor is an invaluable resource who can help your team engage your institution™s leadership and front-line staff to facilitate collaboration and overcome obstacles or barriers that may impede your progress. This mentorship accelerates design and launch of the BOOST interventions at your hospital, assists in the training of your staff and helps you assess outcomes. To learn more about joining the BOOST online community or becoming a mentored implementation site, visit www.hospitalmedicine.org/BOOST. Again, welcome to the Second Edition of the Project BOOST Implementation Guide. The Project BOOST Team thanks you for working to improve patient care and wishes you much success at achieving Better Outcomes by Optimizing Safe Transitions.Chase Coffey, MD, MS Jeff Greenwald, MD, SFHM Tina Budnitz, MPH Mark V. Williams, MD, FACP, MHM What™s New in the Second Edition?With the new edition, SHM has incorporated the latest data from the medical literature on improving care transitions, and has redesigned the Implementation Guide ® sites. The Implementation Guide includes ˜ve sections: ® Toolkit many highly successful organizations such as Toyota. In addition, the BOOST tools have been updated, re˜ned and are easier to use. ii
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Section I: Improving Care Transitions Chase Coffey, MD, MS; Jeffrey L. Greenwald, MD, SFHM; Mark V. Williams, MD, FACP, MHM A Patient™s Story 2Better Outcomes by Optimizing Safe Transitions 3Section II: Laying the Foundation for Improvement Chase Coffey, MD, MS; Jeffrey L. Greenwald, MD, SFHM; Mark V. Williams, MD, FACP, MHM Step 1: Ensure support from the institution 11Step 2: Assemble an effective team 13Step 3: Clarify key stakeholders, reporting hierarchy and approval process 17 Step 5: Set SMART goals and a timeline 19Step 6: Decide on key metrics and a measurement plan 20Step 7: Choose a hospital care unit on which to implement BOOST 21Section III: Getting to Work on Improving Transitions of Care Chase Coffey, MD, MS; Jeffrey L. Greenwald, MD, SFHM; Mark V. Williams, MD, FACP, MHM Step 1: Understand the background context at your institution 27Step 2: Understand how your current care transition process functions and where it fails 28Step 3: Establish a quantitative data collection plan 32Step 5: Select and tailor interventions to ˜x the root causes of any de˜ciencies 37 Step 10: Spread the improvement 50Table of ContentsPROJECT BOOST® IMPLEMENTATION GUIDEiii
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Table of ContentsSection IV: The BOOST® Toolkit Jeffrey L. Greenwald, MD, SFHM; Mark V. Williams, MD, FACP, MHM; Chase Coffey, MD, MS; Jing Li, MD, MS; Robert Young, MD, MS Introduction to BOOST Tools 52Assessing Patient Risk for Adverse Events After Discharge Š The 8Ps 53Assessing the Patient™s Preparedness for Transitioning Out of the Hospital 56Patient-Centered Written Discharge Instructions 57Teach Back 58Follow-up Telephone Calls 60Follow-up Appointments 62Post-Acute Care Transitions 66Medication Reconciliation 69Section V: Best Practices in Care Transitions Annotated Bibliography Jing Li, MD, MS; Jessica Phillips, MS; Mark V. Williams, MD, FACP, MHM Appendices Appendix A: Teach Back Process 110Appendix B: Talking Points to Garner Institutional Support 111Appendix C: Sample Letter to Administration 113Appendix E: Record Your Work 120Appendix F: Tools for Running an Effective Meeting 129Appendix G: Tools for Care Transition Improvement Team Roster 130Appendix H: Tools for Identifying Key Stakeholders, Committees and Groups 133 Appendix J: Tools for Establishing General Aims 135Appendix K: 8P Tool 136Appendix L: General Assessment of Preparedness (GAP Tool) 137Appendix M: Patient PASS: A Transition Record and Discharge Patient Education Tool (DPET) 138Appendix N: The Project BOOST® Advisory Board (original toolkit) 139iv
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