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National Priorities Partnership: Care Coordination
EDITORIAL OPINION
National Priorities Partnership: Care Coordination Vallire D. Hooper, PhD, RN, CPAN, FAAN
THIS EDITORIAL PRESENTS the sixth in a continuing series of editorials examining the challenges and goals established by the National Priorities Partnership (NPP), which is charged with developing a vision for world-class, affordable health care.1 The NPP has established six priority areas which they believe, if addressed, will significantly improve health care on the national level. The fourth of these priorities is focused on care coordination within and across all health care organizations, settings, and levels of care. Care coordination is a particularly significant issue as the chronicity of the US population’s health care status continues to intensify. One hundred and twenty-five million Americans were living with at least one chronic illness at the beginning of this decade. That number, however, is expected to grow to at least 157 million by 2020, with 81 million dealing with multiple chronic conditions. Individuals with multiple chronic conditions may see up to 16 physicians annually, with the coordination of care between these multiple health care providers being scant to nonexistent. This lack of care coordination, communication, and appropriate follow-up results in confusion for both provider and patient, and contributes to poor outcomes that include medication errors and preventable hospital readmissions and emergency department visits.1 The purpose of care coordination is to ensure that patients’ needs and preferences for health care services are understood, and more importantly, that these preferences are communicated as patients are moved from one health care setting to another, or from department/
The ideas or opinions expressed in this editorial are those solely of the author and do not necessarily reflect the opinions of ASPAN, the Journal, or the Publisher. Vallire D. Hooper, PhD, RN, CPAN, FAAN, is a Perianesthesia Consultant and Assistant Professor, School of Nursing, Medical College of Georgia, Augusta, GA. Address correspondence to Vallire D. Hooper, 10 Park Place Circle, Augusta, GA 30909; e-mail address: [email protected]. Ó 2010 by American Society of PeriAnesthesia Nurses 1089-9472/10/2501-0001$36.00/0 doi:10.1016/j.jopan.2010.01.004 Journal of PeriAnesthesia Nursing, Vol 25, No 1 (February), 2010: pp 1-2
unit to another within a health care facility, or as care is shared between a primary health care provider and specialist.1 Care coordination is a particularly challenging mandate in the perianesthesia setting as care is being shared between a primary care provider and multiple specialists, but care is also transferred within multiple departments in an accelerated manner over a very brief period of time. The sharing of patient care between a primary care provider and at least one specialist is a standard criterion for all patients entering the perianesthesia setting. At a minimum, a patient has been referred to a surgeon or endoscopist for a procedure requiring nurse-administered moderate sedation. Procedures requiring general and/or regional anesthesia require coordination of care between a primary provider, anesthesia provider, and surgeon. If the patient has a history of chronic health problems, numerous other specialists may be involved in the patient’s routine care prior to his or her referral for a sedation or surgical procedure, and these specialists may or may not have been consulted prior to the patient’s referral for the procedure. If a patient experiences complications during the course of their perianesthesia care, additional specialists may be consulted. While one would like to think that there is frequent and open communication between the primary care provider and specialists directing the care of the patient in the perianesthesia setting, we all realize that this is not necessarily the case. This lack of coordination, however, may result in adverse outcomes due to the lack of a comprehensive picture of the patient’s health care status by any one provider in the perianesthesia setting. We continue to hear much discussion about ‘‘health care homes’’ and ‘‘patient navigators’’ in the current health care reform debates, but who will be the ‘‘travel agent’’ when the patient takes that short vacation in the surgical services setting? Should each patient entering the perianesthesia continuum have a personnel navigator, a perianesthesia advocate charged with insuring a coordinated plan of patient care from preadmission testing to discharge home, to perhaps include a brief window of time after discharge? Is this a nursing role that should be explored? 1
VALLIRE D. HOOPER
2
Medication reconciliation and transfer-of-care (patient handoff) are additional care coordination priorities that are prevalent issues in the perianesthesia setting. A search of JOPAN articles using the term ‘‘medication reconciliation’’ yielded 16 results.2 Medication reconciliation must occur at each point of care, a particularly challenging issue considering the number of ‘‘points of care’’ in the perianesthesia setting. Perianesthesia nurses, particularly those working in preadmission testing, however, may be the only care providers having access to the full array of every medication that a patient may be taking, to include medications that when taken in combination, may put the patient at risk for adverse effects. While we are not the patient’s primary providers or health care home, we may indeed serve as an important link in the effort to reduce medication associated adverse events. A search on the term ‘‘transfer of care’’ yielded 23 results.2 A patient entering the perianesthesia arena is typically guaranteed a minimum of three transfers of care. Ross and Ranum,3 in a claims analysis study examining patient safety issues in the PACU and day surgery, found that 23% of risk management issues in PACU cases and 18% in day surgery cases were attributable to communication and documentation issues. This study was limited to medical claims as insured by one company, so it is likely that the true incidence of communication and documentation issues contributing to adverse patient care events in the perianesthesia setting is likely much higher. And while there is a considerable amount of research regarding safe practices for transfer of care in the health care facility setting, research exploring safe transfer of the ambulatory
surgery patient to the home care setting is essentially nonexistent. Given hospital readmission and/or emergency department visits related to postoperative complications, however, it is quite likely that ‘‘transfer of care’’ to the home care setting is an area in need of further refinement and exploration. The National Priorities Partnership has established four goals concerning care coordination1: 1. Health care organizations and their staff will continually strive to improve care by soliciting and carefully considering feedback from all patients (and families as appropriate) regarding coordination of care during transitions. 2. Medication information will be clearly communicated to patients, family members, and the next health care professional and/or point or organization of care, and medications will be reconfirmed each time a patient experiences a transition in care. 3. All health care organizations and their staff will work collaboratively with patients to reduce 30day readmission rates. 4. All health care organizations and their staff will work collaboratively with patients to reduce preventable emergency visits. Each of these goals has implications for the perianesthesia setting. I encourage you to work within your health care facilities to increase your efforts to improve care coordination and contribute to the national effort to transform the nation’s health care system.
References 1. NPP. National priorities and goals: Aligning our efforts to transform American’s healthcare. Washington, DC: National Priorities Partnership; 2008. 2. Journal of PeriAnesthesia Nursing. www.jopan.org. Accessed January 10, 2010.
3. Ross J, Ranum D. Improving patient safety by understanding past experiences in day surgery and PACU. J Perianesth Nurs. 2009;24: 144-151.
National Priorities Partnership: Care Coordination Vallire D. Hooper, PhD, RN, CPAN, FAAN
THIS EDITORIAL PRESENTS the sixth in a continuing series of editorials examining the challenges and goals established by the National Priorities Partnership (NPP), which is charged with developing a vision for world-class, affordable health care.1 The NPP has established six priority areas which they believe, if addressed, will significantly improve health care on the national level. The fourth of these priorities is focused on care coordination within and across all health care organizations, settings, and levels of care. Care coordination is a particularly significant issue as the chronicity of the US population’s health care status continues to intensify. One hundred and twenty-five million Americans were living with at least one chronic illness at the beginning of this decade. That number, however, is expected to grow to at least 157 million by 2020, with 81 million dealing with multiple chronic conditions. Individuals with multiple chronic conditions may see up to 16 physicians annually, with the coordination of care between these multiple health care providers being scant to nonexistent. This lack of care coordination, communication, and appropriate follow-up results in confusion for both provider and patient, and contributes to poor outcomes that include medication errors and preventable hospital readmissions and emergency department visits.1 The purpose of care coordination is to ensure that patients’ needs and preferences for health care services are understood, and more importantly, that these preferences are communicated as patients are moved from one health care setting to another, or from department/
The ideas or opinions expressed in this editorial are those solely of the author and do not necessarily reflect the opinions of ASPAN, the Journal, or the Publisher. Vallire D. Hooper, PhD, RN, CPAN, FAAN, is a Perianesthesia Consultant and Assistant Professor, School of Nursing, Medical College of Georgia, Augusta, GA. Address correspondence to Vallire D. Hooper, 10 Park Place Circle, Augusta, GA 30909; e-mail address: [email protected]. Ó 2010 by American Society of PeriAnesthesia Nurses 1089-9472/10/2501-0001$36.00/0 doi:10.1016/j.jopan.2010.01.004 Journal of PeriAnesthesia Nursing, Vol 25, No 1 (February), 2010: pp 1-2
unit to another within a health care facility, or as care is shared between a primary health care provider and specialist.1 Care coordination is a particularly challenging mandate in the perianesthesia setting as care is being shared between a primary care provider and multiple specialists, but care is also transferred within multiple departments in an accelerated manner over a very brief period of time. The sharing of patient care between a primary care provider and at least one specialist is a standard criterion for all patients entering the perianesthesia setting. At a minimum, a patient has been referred to a surgeon or endoscopist for a procedure requiring nurse-administered moderate sedation. Procedures requiring general and/or regional anesthesia require coordination of care between a primary provider, anesthesia provider, and surgeon. If the patient has a history of chronic health problems, numerous other specialists may be involved in the patient’s routine care prior to his or her referral for a sedation or surgical procedure, and these specialists may or may not have been consulted prior to the patient’s referral for the procedure. If a patient experiences complications during the course of their perianesthesia care, additional specialists may be consulted. While one would like to think that there is frequent and open communication between the primary care provider and specialists directing the care of the patient in the perianesthesia setting, we all realize that this is not necessarily the case. This lack of coordination, however, may result in adverse outcomes due to the lack of a comprehensive picture of the patient’s health care status by any one provider in the perianesthesia setting. We continue to hear much discussion about ‘‘health care homes’’ and ‘‘patient navigators’’ in the current health care reform debates, but who will be the ‘‘travel agent’’ when the patient takes that short vacation in the surgical services setting? Should each patient entering the perianesthesia continuum have a personnel navigator, a perianesthesia advocate charged with insuring a coordinated plan of patient care from preadmission testing to discharge home, to perhaps include a brief window of time after discharge? Is this a nursing role that should be explored? 1
VALLIRE D. HOOPER
2
Medication reconciliation and transfer-of-care (patient handoff) are additional care coordination priorities that are prevalent issues in the perianesthesia setting. A search of JOPAN articles using the term ‘‘medication reconciliation’’ yielded 16 results.2 Medication reconciliation must occur at each point of care, a particularly challenging issue considering the number of ‘‘points of care’’ in the perianesthesia setting. Perianesthesia nurses, particularly those working in preadmission testing, however, may be the only care providers having access to the full array of every medication that a patient may be taking, to include medications that when taken in combination, may put the patient at risk for adverse effects. While we are not the patient’s primary providers or health care home, we may indeed serve as an important link in the effort to reduce medication associated adverse events. A search on the term ‘‘transfer of care’’ yielded 23 results.2 A patient entering the perianesthesia arena is typically guaranteed a minimum of three transfers of care. Ross and Ranum,3 in a claims analysis study examining patient safety issues in the PACU and day surgery, found that 23% of risk management issues in PACU cases and 18% in day surgery cases were attributable to communication and documentation issues. This study was limited to medical claims as insured by one company, so it is likely that the true incidence of communication and documentation issues contributing to adverse patient care events in the perianesthesia setting is likely much higher. And while there is a considerable amount of research regarding safe practices for transfer of care in the health care facility setting, research exploring safe transfer of the ambulatory
surgery patient to the home care setting is essentially nonexistent. Given hospital readmission and/or emergency department visits related to postoperative complications, however, it is quite likely that ‘‘transfer of care’’ to the home care setting is an area in need of further refinement and exploration. The National Priorities Partnership has established four goals concerning care coordination1: 1. Health care organizations and their staff will continually strive to improve care by soliciting and carefully considering feedback from all patients (and families as appropriate) regarding coordination of care during transitions. 2. Medication information will be clearly communicated to patients, family members, and the next health care professional and/or point or organization of care, and medications will be reconfirmed each time a patient experiences a transition in care. 3. All health care organizations and their staff will work collaboratively with patients to reduce 30day readmission rates. 4. All health care organizations and their staff will work collaboratively with patients to reduce preventable emergency visits. Each of these goals has implications for the perianesthesia setting. I encourage you to work within your health care facilities to increase your efforts to improve care coordination and contribute to the national effort to transform the nation’s health care system.
References 1. NPP. National priorities and goals: Aligning our efforts to transform American’s healthcare. Washington, DC: National Priorities Partnership; 2008. 2. Journal of PeriAnesthesia Nursing. www.jopan.org. Accessed January 10, 2010.
3. Ross J, Ranum D. Improving patient safety by understanding past experiences in day surgery and PACU. J Perianesth Nurs. 2009;24: 144-151.