Finding HH's Flow: NTOCH Aims to Improve Patient Movement, Build Transparency

Nurse Transition of Care Handoff (NTOCH) is the next Better Flow communications processes initiative that aims to optimize the time it takes to transition a patient from the ED to a unit through instantaneous visuals to indicate when and where a patient is ready to move to the next phase of care.

The NTOCH tool helps nurses initiate a handoff in eRecord, optimizing efficiency through technology. When updating patient information in eRecord, real-time notifications and icon changes are created, alerting staff when the patient is ready to transition to the next phase of care. This visibility is multi-disciplinary, allowing unit secretaries to assist with notifying staff of patient flow changes.

Melissa Derleth, MS, RN, NEA-BC, Chief Nursing Officer says, “The transition of care handoff initiative leverages eRecord to address historical challenges in moving patients between units and departments.  This change allows for nurses involved in patient flow to stay focused on patient care and spend less time tending to missed phone calls and delays. We have moved towards these updated features in eRecord so staff can easily see what steps have been completed within the transfer process.  Allowing for additional visuals, NTOCH assists with transparent communication and is expected to save significant time in the transfer process.  We are currently seeing positive trends and continue to address important feedback and concerns during the transition.”

All of the patient’s relevant information is on the screen with the NTOCH request so that nurses from both departments can review the same information simultaneously. The receiving nurse has the ability to acknowledge and flag the need for additional follow-up communication. When the request is acknowledged, the nurse sending the patient sees the icon change indicating that the unit is ready to receive the patient.

 Better Flow at a Glance

The Better Flow Program is made up of projects grouped into initiatives, ranging from discharge milestones to process automation.

As our health system continues to expand, having consistent information available in eRecord will be more important than ever. For example, having a standard definition of when a patient is medically ready to be discharged will allow us to more accurately report on outcomes and make effective process improvements. Automating handoffs, transfers and EVS workflows will cut down on the need for phone calls to check on patient or room statuses.

“Patient flow is one of our enterprise’s top priorities because it’s at the root of patient and clinician satisfaction,” explains Michael Apostolakos, MD, Chief Medical Officer for Strong Memorial and Highland Hospitals. “Using our technology to facilitate flow means we have data to help us identify blockages and opportunities to keep improving. There is not one person at this organization who won’t feel the benefit of this program.”

The names and departments used in this article’s narrative are fictional and do not reflect the performance nor occurrence of specific persons, teams, departments, or events in the enterprise.

Smiling woman wearing braided hair, nurse scrubs, and stethoscope standing in a hospital with her arms crossed. María, an LPN, has just started her shift in her unit and gets to work tending to her assigned patients. After making her rounds, she checks in at her station when the phone rings. It’s Ricky, an LPN from the ED, calling to give a report on a patient assigned to be transported to Maria’s unit.

Maria sees that the bed this patient is planned to go into still needs to be turned over- Environmental Services (EVS) is short-staffed today. She relays this to Ricky, advising him to check again in 20 minutes after the EVS team has the chance to turn over a couple of beds.

Ricky calls back about 30 minutes later, but Maria is off the floor with another patient. 15 minutes later, Ricky calls again and finally connects with Maria to handoff the patient to a ready bed.

Nearly an hour has passed between the time the patient was ready to transfer and the time they occupied a bed. Unfortunately, as a patient, waiting is a common occurrence and can’t be helped given the circumstances… or can it?

Overhauling the patient flow process is a huge undertaking but a critical one. That’s where the Better Flow Program comes in: with new ways of working in (and around) eRecord that aims to help reduce or eliminate delays caused by ineffective communication methods.

10/23/2023