Safe Hospital to Home Transitions, Mt. Auburn Hospital
Patients in transition to homecare following hospital discharge are at risk for medication errors and readmissions, especially patients with multiple comorbidities. Hospitals, home health agencies, and the primary care providers responsible for patients outside the hospital typically work in different organizations with separate systems and processes. This project uses systems engineering methods to understand, analyze, and redesign the hospital-to-homecare transition process at Mount Auburn Hospital. The objective is to improve health outcomes for patients receiving home health services post-hospitalization and in danger of re-hospitalization as measured by inpatient, emergency department, skilled nursing facility utilization, and patient satisfaction.
A team of industrial engineers, primary care physicians, the Director of Case Management, and the Director of Quality and Performance Improvement met weekly as part of an interdisciplinary patient safety learning lab. Analysis of the existing system and redesign initiatives included mapping the current process via swim lane diagrams, identifying failure sources using failure modes effects analysis (FMEA), and redesigning the workflow utilizing Functional Resonance Analysis Method (FRAM). Additionally, the team considered transitional care systems internal and external to the hospital to assess the robustness of new workflow.
Partners & Research Team
Dr. J. Benneyan, Ph. D., HSyE
Ashley A. Holmes, MS, HSyE
Catarina Smith, HSyE
Nicole Nehls, HSyE
Christine Junod, HSyE
Erica L. Reaves, Harvard T. H. Chan School of Public Health
Matthew Carmody, MD, Mount Auburn
Linda Powers, MD, Mount Auburn
Swim lane diagrams underscored the lack of communication between various healthcare providers during transitional care. This realization prompted the team to invite the Director of Case Management to join the interdisciplinary team as a permanent member. FMEA assisted the team in defining the most critical failures in the existing system. Due to the breadth and depth of stakeholders present for the FMEA, the team achieved a deeper understanding of existing failure types, effects, and probabilities of occurrence. Using this information, the team developed a FRAM model to design and vet a new hospital-to-homecare workflow for high-risk patients. Insights gained from effectively applied systems engineering approaches led to effective collaboration between multidisciplinary stakeholders involved in transitional care. Furthermore, these insights promoted dialogues that, when coupled with systems engineering tools, resulted in a new workflow design for high-risk patients that addressed the communication failings of the existing system.