Improving Patient Safety in Medical Offices: A Resource List for Users

Resources by Dimension (continued)

Dimension 8. Communication Openness

  1. Arizona Hospital and Healthcare Association SBAR Communication
    http://www.azhha.org/patient_safety/sbar.aspx

    This SBAR (Situation-Background-Assessment-Recommendation) Communication toolkit, available for download through the Arizona Hospital and Healthcare Association, is designed to assist facilities through the implementation and training of SBAR communication. Items included in this tool kit are samples of SBAR documents and staff education, including practice scenarios to use SBAR and policy recommendations.

  2. E-Mail Enhances Communication With and Access to Pediatrician for Patients and Families
    http://www.innovations.ahrq.gov/content.aspx?id=1693

    This featured profile is available on AHRQ's Health Care Innovations Exchange Web site. A pediatric subspecialist offered the families of his patients the opportunity to contact him via e-mail, with formal guidelines established with respect to the appropriate use of the system (e.g., content, length, response time). More than 90 percent of families offered the service enrolled, with approximately 40 percent using the service during a 2-year period. Families using the service reported enhanced communication with and access to the pediatrician. The physician found that use of the e-mail service saved him time versus answering the same inquiries via telephone.

  3. SBAR Technique for Communication: A Situational Briefing Model
    http://www.ihi.org/IHI/Topics/PatientSafety/SafetyGeneral/Tools/SBARTechniqueforCommunicationASituationalBriefingModel.htm

    The SBAR technique provides a framework for communication between members of the health care team about a patient's condition. This tool from IHI has two documents. The first, "SBAR Report to Physician About a Critical Situation," is a worksheet/script a provider can use to prepare to communicate with a physician about a critically ill patient. The second, "Guidelines for Communicating With Physicians Using the SBAR Process," details how to carry out the SBAR technique.

Cross-references to resources already described: 

Return to Contents

Dimension 9. Patient Safety and Quality Issues

Access to Care

  1. Balance Supply and Demand on a Daily, Weekly, and Long-Term Basis
    http://www.ihi.org/IHI/Topics/OfficePractices/Access/Changes/BalanceSupplyandDemandonaDailyWeeklyandLongTermBasis.htm

    The foundation of improved access scheduling is matching supply and demand on a daily, weekly, and monthly basis. This IHI Web page contains information on communication methods to manage the daily and weekly supply and demand variation and to anticipate and plan for recurring seasonal events.

  2. Decrease Demand for Appointments
    http://www.ihi.org/IHI/Topics/OfficePractices/Access/Changes/DecreaseDemandforAppointments.htm

    One key way for a health care system to improve access is to reduce unnecessary demand for various services so that patients needing a particular service can receive it in a timely way. This IHI Web page contains information on decreasing demand for appointments, such as using alternatives to in-person visits (e.g., telephone, E-mail).

  3. Measure and Understand Supply and Demand
    http://www.ihi.org/IHI/Topics/OfficePractices/Access/Changes/MeasureandUnderstandSupplyandDemand.htm

    Improving access is all about getting supply and demand in equilibrium, meaning there is no backlog of appointments and no delay between when the demand is initiated and when the service is delivered. This IHI Web page contains information on how to measure and understand supply and demand, including tools and resources such as the practice supply worksheet and the true demand formula.

  4. Optimize the Care Team
    http://www.ihi.org/IHI/Topics/OfficePractices/Access/Changes/OptimizetheCareTeam.htm

    Optimizing the care team is critical to maximizing the supply of the clinic and improving the daily flow of work. This IHI Web page contains information on decreasing demand for appointments, including links to tools such as the practice supply worksheet.

  5. Open Scheduling and Related Strategies Lead to Zero Wait Time for Appointments and Few No Shows at Family Practice
    http://www.innovations.ahrq.gov/content.aspx?id=1907

    This featured profile is available on AHRQ's Health Care Innovations Exchange Web site. A five-physician family practice in the suburbs of Indianapolis ensures maximum patient access by providing same-day appointments through an open access scheduling system, extended hours, direct telephone access to physicians after hours, electronic visits, and other strategies. As a result, patients can get an appointment without any delay (in contrast to the typical practice where patients often must wait 30 to 60 days for an appointment), and the practice enjoys a no-show rate of only 5 percent.

  6. Reduce Scheduling Complexity
    http://www.ihi.org/IHI/Topics/OfficePractices/Access/Changes/ReduceSchedulingComplexity.htm

    Complex schedules, with many appointment types, times, and restrictions, can increase total delay in the system because each appointment type and time creates its own differential delay and queue. This IHI Web page contains information on how to reduce scheduling complexity.

  7. Revamped Scheduling Systems Promote Access, Reduce No Shows, and Enhance Quality, Patient Satisfaction, and Revenues in Primary Care Practice
    http://www.innovations.ahrq.gov/content.aspx?id=1856

    This featured profile is available on AHRQ's Health Care Innovations Exchange Web site. Using the "advanced access model," a primary care practice revamped its appointment scheduling, tracking, and reminder processes, with the goal of enhancing access to same-day appointments. A pre- and post-implementation comparison shows that the program enhanced access to same-day appointments, reduced no shows, and increased the provision of evidence-based care, patient satisfaction, patient volume, and revenues.

  8. Six Sigma-Inspired Workflow Redesign Enhances Access to Care and Increases Patient Satisfaction, Visits, and Revenues in Obstetrics and Gynecology Residency Clinic
    http://www.innovations.ahrq.gov/content.aspx?id=1868

    A hospital's obstetrics and gynecology residency training clinic used Six Sigma methodologies to identify and address inefficiencies in workflow processes related to patient flow and staffing. Through redeployment of staff, revised scheduling processes, and other changes, the program significantly reduced waiting times for appointments and the length of clinic visits. The program also increased patient satisfaction and clinic volume and revenues. 

Patient Identification

  1. Patient Identification
    http://www.camlt.org/DL_web/963_pat_id.pdf (PDF file, 110 KB; Plugin Software Help).

    This course packet prepared for the California Association for Medical Laboratory Technology outlines the importance of patient identification and explains how this task can be completed in inpatient and outpatient settings.

Cross-reference to resource already described:

Charts and Medical Records

  1. Electronic Medical Record-Facilitated Workflow Changes Enhance Quality and Efficiency, Generating Positive Return on Investment in Small Pediatrics Practice
    http://www.innovations.ahrq.gov/content.aspx?id=274

    This featured profile is available on AHRQ's Health Care Innovations Exchange Web site. Four Seasons Pediatrics, a three-physician group in upstate New York, redesigned its workflow, reduced staffing costs, and enhanced quality of care while adopting an electronic medical record. The group also achieved a positive return on investment within 2.5 years, earning financial rewards through the Bridges to Excellence program and other pay-for-performance programs.

  2. TransforMED Health Information Technology Resources
    http://transformed.com/resources/HIT.cfm

    TransforMED is a subsidiary of the American Academy of Family Physicians. This Web site features health information technology resources on the following topics: electronic health record, electronic prescribing, disease and population management software/registries, evidence-based decision support, and Web site/patient/portal.

Cross-reference to resource already described:

Medical Equipment

No resources have been identified at this time.

Medication

  1. Automated Pharmacy Alerts Followed by Pharmacist-Physician Collaboration Reduce Inappropriate Prescriptions Among Elderly Outpatients
    http://www.innovations.ahrq.gov/content.aspx?id=1780

    This featured profile is available on AHRQ's Health Care Innovations Exchange Web site. Kaiser Permanente Colorado developed a computerized alert system to notify pharmacists when elderly patients are prescribed potentially inappropriate medications. Alerted pharmacists consult with the physicians to discuss the prescription. A 1-year prospective randomized controlled trial found that the program reduced inappropriate prescriptions, with 1.8 percent of intervention patients receiving them, compared to 2.2 percent of control group patients.

  2. Aurora Health Care Medication List Toolkit
    http://www.patientsafety.org/page/109587/

    This toolkit is designed to help health care organizations create an accurate medication list in the outpatient setting through a patient-centered approach.

  3. Look-Alike, Sound-Alike Medication Names
    http://www.ccforpatientsafety.org/common/pdfs/fpdf/Presskit/PS-Solution1.pdf (PDF, 658 KB) [Plugin Software Help]

    Confusing drug names is one of the most common causes of medication errors and is a worldwide concern. With tens of thousands of drugs currently on the market, the potential for error created by confusing brand or generic drug names and packaging is significant. This resource from the World Health Organization Collaborating Centre for Patient Safety Solutions provides information about look-alike, sound-alike medication names as well as strategies for improvement.

  4. Medication Safety Reconciliation Toolkit
    http://www.innovations.ahrq.gov/content.aspx?id=2173

    This medication reconciliation toolkit is featured on AHRQ's Health Care Innovations Exchange Web site. From the Department of Defense Patient Safety Program, this tool can help health care providers ensure that their patients receive safe medical care. Medication reconciliation is a systematic process designed to improve communication during transitions of care. It begins with the acquisition and generation of a current, accurate, and single-source medication profile for use by all health care providers dealing with a specific patient at the time any form of care is delivered. This process promotes seamless communication among a patient's care providers to prevent inadvertent duplications or omissions.

  5. Medications At Transitions and Clinical Handoffs (MATCH) Initiative
    http://www.innovations.ahrq.gov/content.aspx?id=1979

    This toolkit is featured on AHRQ's Health Care Innovations Exchange Web site. The goal of the Medications At Transitions and Clinical Handoffs (MATCH) Initiative is to measurably decrease the number of discrepant medication orders and the associated potential and actual patient harm. This toolkit is designed to assist all types of organizations, whether caring for inpatients or outpatients or using an electronic medical record, a paper-based system, or both.

  6. Patient Education and Staff Training Significantly Improves Medication Reconciliation in Outpatient Clinics
    http://www.innovations.ahrq.gov/content.aspx?id=1762

    This featured profile is available on AHRQ's Health Care Innovations Exchange Web site. Mayo Clinic researchers developed a medication reconciliation intervention program for outpatient primary care settings. The program improved the accuracy of medication lists in the practice's electronic medical records relative to patient reports of actual prescription and nonprescription drugs and supplements used. The intervention included communicating with patients so that they were better prepared to provide information about their medications at the time of the visit. It also included provider education on the importance of medication reconciliation and methods to improve documentation through patient and provider collaboration.

  7. Patient Safety Primer: Medication Reconciliation
    http://www.psnet.ahrq.gov/primer.aspx?primerID=1

    Medication reconciliation refers to the process of avoiding inadvertent inconsistencies across transitions in care. It involves reviewing the patient's complete medication regimen at the time of admission, transfer, and discharge and comparing it with the regimen being considered for the new setting of care. The AHRQ Patient Safety Network explains this topic further and provides links for more information on what is new in medication reconciliation.

  8. Reconciliation of Patient and Provider Medication Lists Reduces Discrepancies and Enhances Medication Safety in Physician Clinics
    http://www.innovations.ahrq.gov/content.aspx?id=2048

    This featured profile is available on AHRQ's Health Care Innovations Exchange Web site. PeaceHealth, a nonprofit integrated system, established a process to allow patients and providers in physician offices to reconcile two medication lists: one maintained by patients either manually or on a Web-based personal health record and one maintained by providers on an electronic medical record. The new medication reconciliation process significantly reduced the number of discrepancies between the lists, leading to enhanced safety and high levels of patient and provider satisfaction.

Diagnostics and Tests 

Cross-reference to resource already described:

Return to Contents

Dimension 10. Office Processes and Standardization

  1. Create Contingency Plans
    http://www.ihi.org/IHI/Topics/OfficePractices/Access/Changes/CreateContingencyPlans.htm

    The natural variation in supply and demand that occurs as part of the everyday functioning of a practice often creates problems that contingency plans can address. To avoid disrupting the normal flow of clinic practice, clinics agree on a standard protocol to follow for each event, including clear responsibilities for each staff member. This IHI Web page provides information about how to create contingency plans.

  2. Focus on Variation
    http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/Changes/Focus+on+Variation.htm

    Reduction of variation will improve the predictability of outcomes (may actually exceed customer expectations) and help to reduce the frequency of poor results. This IHI Web page contains information on how to reduce variation, including resources for standardization and developing contingency plans.

  3. Information Technology (IT) Staff-Clinician Team Addresses IT Problems Affecting Providers and Patient Care, Leading to Increased System Usage and Efficiency
    http://www.innovations.ahrq.gov/content.aspx?id=1748

    This featured profile is available on AHRQ's Health Care Innovations Exchange Web site. Mayo Clinic started an initiative involving clinicians and systems engineering analysts who worked together to better customize and align the clinic's information system (Mayo Integrated Clinical Systems, or MICS) to support providers and patient care processes. As a key part of the team's work, staff shadowed providers, observing their interactions with patients and their use of information technology for managing information. The shadowing process led to direct feedback and open dialogue between clinical and project staff, which served as a catalyst for system enhancements, training initiatives, and other improvements designed to enhance work processes, efficiency, and patient care.

  4. Patient Encounter Form
    http://www.innovations.ahrq.gov/content.aspx?id=2521

    This form is featured on AHRQ's Health Care Innovations Exchange Web site. It can be used as a model for clinicians to establish a reminder system to improve quality measures and goals. Patient visits can be guided by this customizable patient encounter form that is designed to incorporate a practice's quality goals and measures. It can be printed automatically at patient arrival, printed manually on demand, or completed using a real-time Web interface.

  5. Real-Time Decision and Documentation Support Increases Adherence to Recommended Care for Respiratory Infections, Diabetes, and Heart Disease
    http://www.innovations.ahrq.gov/content.aspx?id=2431

    This featured profile is available on AHRQ's Health Care Innovations Exchange Web site. Partners HealthCare System seeks to ensure appropriate care for patients with acute respiratory infections, coronary artery disease, and diabetes by providing real-time clinical decision and documentation support through the system's electronic medical record. Pre- and post-implementation pilot studies show that the system has improved the appropriateness of antibiotic prescribing for acute respiratory infections and increased use of appropriate therapies and improved documentation for patients with coronary artery disease and diabetes. Results from a randomized controlled trial of the system have not yet been published.

Cross-references to resources already described:

Return to Contents

Dimension 11. Information Exchange With Other Settings

  1. Onsite Nurses Work With Primary Care Physicians To Manage Care Across Settings, Resulting in Improved Patient Satisfaction and Lower Utilization and Costs for Chronically Ill Seniors
    http://www.innovations.ahrq.gov/content.aspx?id=1752

    This featured profile is available on AHRQ's Health Care Innovations Exchange Web site. Specially trained nurses work with primary care physicians in their offices to improve care for seniors with multiple chronic illnesses by coordinating care, facilitating transitions in care, and acting as the patient's advocate across health care and social settings. Nurses use an electronic health record and a variety of established methods, including disease management, case management, transitional care, self-management, lifestyle modification, caregiver education and support, and geriatric evaluation and management.

  2. Strategies and Tools To Improve Health Care Handoffs and Transitions
    http://www.unmc.edu/rural/patient-safety/tool-time/TT2-053006-DOD-SBAR-SafetyBriefings/DOD%20Handoff%20-%20I%20Pass%20the%20Baton.pdf (PDF file, 99 KB; Plugin Software Help).

    This resource from the Department of Defense provides an overview on the importance of structured handoff processes and provides information on the Joint Commission requirement. The resource illustrates a handoff communication tool that can be recalled through the mnemonic device, "I PASS the BATON."

  3. Transitions of Care Checklist
    http://www.ntocc.org/Portals/0/TOC_Checklist.pdf (PDF file, 200 KB; Plugin Software Help).

    The National Transitions of Care Coalition Advisory Task Force has released a transitions of care list that provides a detailed description of effective patient transfer between practice settings. This process can help to ensure that patients and their critical medical information are transferred safely, quickly, and efficiently.

Cross-references to resources already described:

Return to Contents

Dimension 12. Work Pressure and Pace

  1. E-Mail and Telephone Contact Replaces Most Patient Visits in Primary Care Practice, Leads to More Engaged Patients and Time Savings for Physicians
    http://www.innovations.ahrq.gov/content.aspx?id=1785

    This featured profile is available on AHRQ's Health Care Innovations Exchange Web site. Based on the belief that more than one-half of primary care office visits are unnecessary, GreenField Health relies heavily on e-mail and telephone communications for most patient contacts, which in turn frees staff to see patients who need in-person care in a timely manner. Anecdotal reports indicate that this approach more fully engages patients in their care and decisionmaking, enables better care management, and saves physician and staff time.

  2. Manage Panel Size and Scope of the Practice
    http://www.ihi.org/IHI/Topics/OfficePractices/Access/Changes/ManagePanelSizeandScopeofthePractice.htm

    Managing panel size and the scope of the practice allows a team to balance supply and demand and ensures that they can do today's work today. This IHI Web page also includes links that contain more specific information and strategies for managing panel size and the scope of the practice.

  3. Predict and Anticipate Patient Needs
    http://www.ihi.org/IHI/Topics/OfficePractices/Access/Changes/PredictandAnticipatePatientNeeds.htm

    To ensure that patient needs are met and that patients flow smoothly through the clinic process, staff look ahead on the schedule to identify patient needs for a given day or week. This IHI Web site includes links to more specific information and strategies on predicting and anticipating patient needs.

  4. Recalibrate the System by Working Down the Backlog
    http://www.ihi.org/IHI/Topics/OfficePractices/Access/Changes/RecalibratetheSystembyWorkingDowntheBacklog.htm

    This IHI resource provides information for medical offices on how to reduce and eliminate backlog appointments. Included is a link to a Backlog Reduction Worksheet that helps users understand the extent of their backlog.

Cross-reference to resource already described:

Return to Contents
Proceed to Next Section

Current as of June 2011
Internet Citation: Improving Patient Safety in Medical Offices: A Resource List for Users: Resources by Dimension (continued). June 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/medical-office/2010/moimpdim1.html