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Ticket to Ride

Innovative project empowers patient transporters at Montefiore Medical Center, Bronx, NY.

Computerized paperless technology may be the "in" thing these days, but a piece of paper still can carry its weight in gold. At Montefiore Medical Center, Bronx, NY, that piece of paper is a "must-have" ticket to transport patients to and from ancillary departments.

Montefiore recently implemented a patient safety initiative called the Ticket to Ride, a name derived from the lyrics of the popular Beatles' song. It is in response to a Joint Commission National Patient Safety Goal. That goal requires hospitals to implement a standardized approach to "hand-off" communications with an opportunity to ask and respond to questions.

How It Works

Developed specifically to accompany non-critical patients being transported to diagnostic areas of the hospital, the Ticket to Ride project basically assures the patient's safety by making the transporters become their gatekeepers, according to Jason Adelman, MD, patient safety officer who oversees the project.

"It empowers the transporters and gets them invested in the program, so they believe in it," he told ADVANCE. "It adds a level of importance to their job."

Not an original idea but perhaps the first to be implemented in New York City, the Ticket to Ride "provides important clinical information at a snapshot" to the professional receiving the patient, said Susan McAllen, MSOL, RN, quality manager for emergency services. It includes relevant points to check off concerning the patient's status and space for comments. The points include fall risk, patient orientation, DNR, isolation status and information about the patient's belongings such as eyeglasses, among others.

"We do send the chart down from the floor, but it is very large, and if something goes wrong with the patient, the caregiver needs to get the information quickly," McAllen noted. "It also allows the technologists in the ancillary departments to have the information at their fingertips."

'Really a Nursing Project'

The project got under way after learning about similar programs in other hospitals. McAllen and Justine Huffaker, MS, RN, APRN, NE-BC, director of nursing surgery, headed a multidisciplinary planning committee to tailor the program to Montefiore's specific needs. Naming of a steering committee followed, starting with nurses from the various care units.

"It really is a nursing project, so it was important to have input from nursing staff in different care centers," McAllen stressed.

While standardized in most areas of the hospitals, the Ticket to Ride is handled somewhat differently in Montefiore's emergency and radiology departments because of the high volume of patients - the ED is the "fifth busiest in the country at last count," McAllen noted. Those departments have their own transporters, while other transporters are shared among the other departments.

Rolled Out in Stages

The Montefiore project is being rolled out in stages. Its smallest division, the 356-bed Jack D. Weiler Hospital, implemented the program last summer. Then, after making adjustments from lessons learned at Weiler, it was instituted at the 706-bed Moses Division Hospital, which includes the Children's Hospital at Montefiore. It is set for implementation at Montefiore North Division (formerly Our Lady of Mercy) this year.

"We got feedback from nursing focus groups on the floor plus secretaries, transporters and people from the ancillary units before implementing it at the Moses Division," McAllen explained.

"We did a lot of training at the second roll-out," Adelman added. "For an entire week, 16 hours a day, we had four people walking around, asking questions. We did a lot to announce its coming, then helping implement it."

Two Recommendations

McAllen believes three specific things have contributed to the program's success at Montefiore. "Our introductory internal communication and marketing of the Ticket to Ride was good, so everyone was aware of the program," she said. "We made a big production, delivering tickets with balloons to the departments the day before we started.

"Also, we used a beeper when we went go-live so people could ask questions in real time. That was very helpful. And we found it important to make sure compliance continues."

McAllen said the steering committee continues to look at the compliance rates and ticket information, with the assistance of Joseph Friedman, patient safety analyst, to see whether there is something that can be done better. Friedman reports his findings to leadership groups and has done so throughout the program.

Ticket to Ride

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