The Joint Commission
Travel ticket navigates facility through improved handoffs
After reading this article, you will be able to:
- Discuss tactics for implementation of a travel ticket process
Sometimes, it’s all about the journey, not the destination. And in hospitals, the journey a patient takes can be difficult to track. For this reason, focusing on handoff communication is key. And in some facilities, developing a travel ticket for patients can help improve patient safety and handoff communication.
It was this focus that led Hackensack (NJ) University Medical Center to examine its handoff communication and look for a simple way to improve it.
Handoff communication improvement has been the focus of Joint Commission (formerly JCAHO) National Patient Safety Goals for the past two years but remains a challenge for many facilities.
“The Joint Commission didn’t have any kind of paper requirements for this goal, so we took inventory across the organization to see what was in place as far as handoff communication,” says Renee Harvey, MPA, FACHE, accreditation compliance coordinator at Hackensack.
There were certain areas (e.g., the operating room and postanesthesia care unit) that had well-established handoff systems because of the criticality of the patients involved.
“Other areas, where a patient might go from an inpatient unit to CAT scan, for example, the patient would often go with a transport aid without a chart,” Harvey says.
Hackensack wanted to quickly craft and implement something to improve its handoff communication. Design of the travel ticket took about two months (see “Sample travel ticket” on p. 9).
“The stakeholders met around a table and hammered out the minimum components to make the handoff communication truly effective,” Harvey says. These stakeholders—inpatient nurse directors, outpatient nurse managers, administrative directors, the administrator of patient safety, and the accreditation coordinator—then brought in the education department to create inservices for use of the travel ticket.
First, the facility uses transporters—“the perfect gatekeepers,” Harvey says.
If the trip ticket wasn’t with the patient, the patient didn’t move.
“The process took roughly four to six months to implement,” Harvey says. “We needed to have people buy in and understand the value of using the trip ticket. And we had to have a stopgap, a no-go, in there, and that was the transporter.”
Challenges and breakdowns
The biggest breakdown in use of the trip ticket was inpatient units to ancillary areas, such as radiology. One challenge was making the travel ticket part of the chart on initial implementation.
“We realized we didn’t need to keep the travel ticket; it doesn’t need to be part of the chart,” Harvey says. “The transfer form, used in areas where the level of care changes, is part of the chart.”
Working with specific units has led to some changes to the ticket and how it is used, says Harvey. Many of these changes came from gaining a better understanding of the individual needs of the departments and units.
For other facilities interested in implementing a travel ticket process, Harvey recommends monitoring the handoff process for compliance. “We perform audits monthly,” Harvey says. “Several months passed before we achieved a 99% compliance rate. Goal #2E is a ‘C’ scoring goal. It may be valuable to have audit data available.”
Briefings on The Joint Commission, September 2008, HCPro, Inc.