Path to Home Overview & Education
5E and 5W Surgery
What is Path to Home?
Path to Home is an integral access and flow initiative to
address acute care service delivery and proactive
discharge planning. It is based on service re-design
and integration to create seamless transitions from
admission to discharge.
Our Path to Home goal is to provide our patients,
their families and care team/service providers with
a consistent experience via standardized
processes, communication strategies, and
supporting technologies.
Path to Home Goal
Path To Home Patient Journey
Zone Transition Unit
Daily Care
-Home Care
-Supportive Living
-Long Term Care
-Mental Health
-Primary Care
Community
Decision to Admit (Disposition)
ED
In-patient Acute Unit
ED Consultation
Disposition to In-
patient BedCare Team Activities
Patient
Orientation
to UnitBed Management
Patient Bedside
Whiteboards
Restorative Care
/ Sub-acute
Review
-Communicate to family of patient discharge-Next day “Green Flag call to MD -Care management notification of transition
-Consultant sign off-I-request Pre-Booking prior to 1400h
-Preliminary ETD id. for EMS transfer by 1700-Notify/confirm next day d/c
3 Days Prior to Discharge
ADOD=2 days: Notify Patient /
Family for Planned Family Arrival
Daily Patient Experience
Breakfast/Receive Morning Meds
Assessments/Treatments
In patient team updates patient
on plan of care
Lunch/Receive Afternoon Meds
Assessments/Treatments
In patient Care Team Updated on Care Plan
Dinner/Receive Evening Meds
Patient
Information
Package
Day of Discharge
Triage ED Physician Assessment
Disposition to
Departure
Covenant Health
Path to Home Model
Allied Health and Clinical Support Services
• Lab: timely specimen collection and
results availability for d/c decision
making.• DI: order will require date/priority, test
requested, relevant history and clinical
reason/expected findings.
• Inpatient units will receive a DI schedule
for pt’s with times for next day exams• Allied Health: Prioritize work activities
based on clinical needs, ADOD, resource
requirements and availability.
• EVS: Preplanning resource requirements
based on ADODs and ETDs.• Portering: On time arrival and portering
back up systems.
Access and Flow
• CTC: centralized management and real-time
monitoring.
• Staff utilization: centralized deployment of staff based on site needs.
• Transition Services: Care Coordinator /
Social Work Dyad model..
Care Management Physician declares and updates ADOD
-Early A.M. lab results by program-Discharge order -Confirmed Patient Departure by 1100h
-Inititate room turnover-D/C checklist reviewed & given to patient /
family upon discharge
Care
Management
Care
Management
Day Prior to Discharge
Interprofessional Discharge Checklist
Zone
Transition:
Acute to
Home Care
and LTC
Daily Care
A.M. & P.M. Rapid Rounds
Patient Bedside Whiteboard Update
Bedside Shift Report
A key component to the patient experience is effective
communication between our team members (Physicians,
Nurses, Allied Health, Clinical Support
Services, patients/families, and others).
Formalizing the communication is the key strategy we use
in Path to Home.
Communication is Critical
Path to Home Model
Key Framework Components
1. Inpatient Care Team 2. Allied Health & Clinical
Support Services
3. Patient Access & Flow
Anticipated Date of Departure (ADOD)/Estimated Time of
Departure (ETD)
Lab
(Early AM Lab Results)
Care Traffic Control
(Bed Management)
Rapid Rounds Diagnostic Imaging
(Pre-Booked Imaging Times)
Staff Utilization
(ESP)
Whiteboards
Chart Order & Standardization (Flagging System/Order)
Environmental Services Transition Services
(Care Coordinator/Social Work)
Change of Shift (Bedside Shift Report)
Allied Health
Meals & Breaks (UAS) Portering EMS/IFT
(IRequest & Prebooking)
Discharge Orders/Checklists
We introduce an Anticipated Date of Discharge (ADOD) which anchors our discharge pre-planning activities
It is the foundation to all activities leading up to a patient’s discharge
Anticipated Date of Discharge (ADOD)
Physicians declare ADOD within 24 hours of admission
For Elective Surgery the ADOD will be found on:
Care Pathways
Booking Form
* The Unit Clerk/ Charge Nurse are to transcribe the date from these forms onto the patient Kardex
For Non Elective Surgery ADOD is declared within 24 hours post-operatively for trauma patients :
Physician/ designate
Date to be documented on the patient order sheet
For Medicine Off-service the ADOD will be written on the patient care order sheet as:
ADOD is greater than 5 days ADOD is less than 5 days Or actual date when known
Anticipated Date of Discharge (ADOD)
General Principles
Anticipated Date of Discharge (ADOD)
Booking Form
During Shift Introduction today’s discharges will be
identified
Written on the Kardex
Rapid Rounds
Written on the Bedside Shift Report Form and
communicated between the outgoing and incoming
bedside nurse during “Bedside Shift Report”
Written on the Bedside Whiteboards and communicated
to the patient
How will ADOD be communicated?
Rapid Rounds are:
Structured interprofessional rounds that bring the team together to review the patients’ plan of care
Rapid Rounds are key in creating the consistent daily communication that is imperative in providing quality and safe patient care.
What are Rapid Rounds?
• A.M. Rapid Rounds starting 0815h
• In charting room with the Charge Nurse, Care Coordinator, Physiotherapist, Occupational Therapist
Rapid Rounds Weekdays
Rapid Rounds Weekends
• A.M. Rapid Rounds starting 0815
• In Charting room with the Charge Nurse, Physiotherapist, Occupational therapist
Discharge Activity Tracking Tool (DATT)
Family/facility notification is to be documented on the
DATT
Family/facility Notification of Next Day
Discharge
The Discharge Checklist and all discharge
information will be kept in the chart under the
“Discharge Planning” section.
At discharge the Bedside Nurse reviews the
discharge checklist.
During the P.M. Rapid Round the Charge
Nurse is to identify next day discharges to
ensure discharge instruction is completed.
Discharge instructions identified by the Allied
Health team member will be reviewed prior to
discharge.
Follow unit process-Discharge envelope?
Discharge Checklist
Components of Change of Shift
Unit Assignment Sheet
•Incoming Bedside Nurse reviews
patient assignments and identifies who
to give report to
•Sign in & out for breaks(3 breaks) so
the Charge Nurse knows who is
on unit for patient safety
reasons
•Provides information such as “Clinical
Associate” and “Surgeon on Call”
•Charge Nurse Assigns HCA duties
• Completed by the outgoing Charge
Nurse each shift
• Read by the outgoing Charge Nurse in
report room at shift change
• Program information may also be shared
as part of Key messages
• Should take 2-5 minutes.
Shift Introduction
Shift Introduction
Date Unit Charge Nurse Patient
Census
Closed Beds / OCP Number of
Electives
Patients on
callBed Sickest Patients/New
Info.
PICC # of
Isolation
Goals
of Care
Confused
Agitated
Bed Alarm
DI/
Proc
edur
e
Prep
arati
on
Discharge
s
Patient Transfers
Appointments
(Time/Where/
Escort)
Pote
ntial
Disc
harg
es/
Barr
iers/
Issu
es
Unit Issues Cytotoxic Meds
Key Concepts Family Conferences Miscellaneous
Medworxx
Whiteboards
Discharge sheets
The Inpatient Bedside Shift Report/Change of Shift provides
a formalized process for how we transfer essential patient
information safely and hand off responsibilities between our
staff members.
This allows us to:
Provide quality and continuity of patient care during
change of shift activities
Maintain a safe patient environment
Allows patients and families opportunities to participate in care and decision-making.
Bedside Shift Report
The Bedside Nurse will:
complete their bedside shift report forms for each
assigned patient
provide the Charge Nurse with any patient updates for
next shift report in order to provide the Charge to
Charge unit report
Patient Status Updates for
Next Shift Report
Bedside Shift Report Form
•Will be completed by the
bedside nurse
•Will be kept in the bedside
binder
•Ensure that the top portion is
updated and pertinent
•Patient Safety checks are
critical
We have a standardized flagging system on all inpatient
units
The “Discharge Planning” section is at the back of the
chart
Chart Order & Standardization
The Patient Bedside Whiteboard is a tool placed near each patient’s bedside to support communication between the care team, the patient and their family.
Bedside whiteboards have proven to be tools that enhance the patient and family experience.
Ensuring consistent updating and sharing of information with our patients and families allows them to become active participants in their plan of care.
Bedside Whiteboards
On admission verbal consent is obtained from the patient
prior to use of the Patient Bedside Whiteboard.
The Bedside Nurse will update each of their patient’s
whiteboards daily at shift changes and when there are
any additional changes throughout the day.
PT/OT will also update the whiteboards with any changes to the mobility.
Bedside Whiteboards
Bedside Whiteboard Example
Lab collection times will be adjusted to provide results of
next day morning routine tests by defined times.
Collections for the surgical program are:
At 0600h 1 medical lab assistant starts collections on 5E
then 6E
At 0600h 1 medical lab assistant starts collections on 5W
then 6W
Laboratory Services
The ordering physician/designate will ensure orders for all DI exams are complete and include:
Procedure requested
Date/
Time
Priority required
Clinically relevant history
Clinical Reason/expected findings for the test
Diagnostic Imaging
What the Radiologist Receives
At 1930h daily a next day Diagnostic Imaging Report will
print to the Inpatient Unit with Pre-booked Exams.
Before 2030h the Charge Nurse will verify that the times
do not conflict with other tests/appts etc.
At 0555h a complete report will print with scheduled and
unscheduled exams.
Scheduled times will facilitate patient care and
communication.
Next Day Diagnostic Imaging Report
Diagnostic Imaging Report
Diagnostic Scheduled Exam Report
•All DI Exams that have a time
between 0700h and 1700h are pre-
booked
•Times with a 0001 require more
information so they are not pre-
booked (i.e. Radiologist approval,
interventional procedure form
completed)
•If a patient has 2 or more procedures
DI will try to coordinate exams
•On the unit computer desktops a icon
for Radiology has been added to
review preparations etc.
Portering
Porters will check in with the Inpatient units on unit arrival
when transporting a patient, and notify dispatch on
completion of a transport.
Dispatch will notify sending unit if unable to send a porter
within a defined period of time.
All Pre-booked Diagnostic Imaging times require the
patient to be ready for transport 30 minutes prior to the
time given
Shift Preparation by Charge Nurse
Days Evenings Nights
Unit Assignment Sheet
(UAS) with HCA Assignment
Shift Introduction Form
1930h DI Schedule Exam
Printed/Times Confirmed
Discharge Activity
Tracking Tool (DATT)
VAX census
Unit Assignment Sheet
(UAS) with HCA Assignment
Shift Introduction Form
1930h DI Schedule Exam
Printed/Times
/Isolation/Confirmed
Discharge Activity
Tracking Tool (DATT)
VAX census
Unit Assignment Sheet
(UAS) with HCA Assignment
Shift Introduction Form &
DI Scheduled Exams Read
EMS Patient Transfer
Form & Documents Bundled
0555h DI Schedule Exam
Posted
Discharge Activity
Tracking Tool (DATT)
VAX census
Room Turnover Using Citipage
Room Stripping Prior to Citipage
Patient Room Stripping Guidelines
The patient room will be stripped within 10 minutes of notification of the patient being discharged. This must be completed before the arrival of Environmental Services and is a shared responsibility of the Bedside Nurse and or designate. Ensure the following is completed prior to Environmental Service arrival to the room:
• All equipment and supplies are removed from the patient room.
This includes IV poles and fluids, basins, measuring cans, bed pans, oxygen tubing, scissors, tape, medications, and any patient care supplies.
• All bodily fluids MUST be removed by a nurse.
Inner canister linings must be removed even if there is no visible drainage in them
• All linen/personal belongings must be removed from the patient room:
from bed
bedside table
closet
over bed table & washroom
Remember:
•Prior to requesting the
room clean in “Citipage” ensure
the room has been stripped
•With centralized dispatch
notification via text pagers
arrival of environmental services
staff to clean a bed has been
quicker
Citipage Screen
Remember:
•The “Icon” is on the desktop of the
unit computers
•From 0730-2330h enter the
number
7804010474 on the
Screen
•After 2330h call
780-445-7086
For all anticipated discharges, a request is submitted in
IRequest by 1400h on the day prior to discharge
Pre-booking of potential next day discharges is also
recommended prior to 1400h to ensure timely transfers
(better to book and cancel)
IRequest Pre-booking
For transfer requests made prior to 1400h, “Dispatch/IRequest” will
input a next day transfer time at 1700h
The Unit Clerk will check for the next day confirmed time at 1700h
The Estimated Time of Arrival will be written on the Discharge
Activity Tracking Tool (DATT) and whiteboard
For transfers that are confirmed back to a facility, the facility can
also be notified and document on the DATT
IRequest 1700h Confirmed Times
Patient Transfer Summary
Must be completed on all
transfers using a EMS/IFT crew
Please sign both pages
For next day transfers please
initiate the form when the request
is made and place per unit
process
The Care Coordinator & Social Worker Dyad Model is a
shared and complementary decision-making relationship.
The Care Coordinator and Social Worker develop plans
and make recommendations jointly that impact the patient
discharge plan.
Responsibilities and accountabilities overlap significantly,
but each partner also has his/her own focus as mutually
determined according to role definitions and distribution of
workload.
Transition Services
Principle: The right patient, in the right bed, at the right time, cared
for by the right provider
Bed management consistently anticipates bed capacity and resource needs
for the hospital through coordinated responsibilities and tasks.
The Bed Manager, Bed Coordinators, and associated teams (Staffing Office,
Environmental Services, and Portering) oversee the overall hospital
performance and ensure backup systems are activated at defined thresholds
to avoid crisis or over-capacity.
Bed management works collaboratively with all teams and stakeholders to
provide safe, appropriate, and timely placement of patients within the hospital
Bed Management Model
We will be asking for front line staff feedback throughout the Path to Home journey.
A combination of weekly audits and on unit monitoring will occur during the test phase.
Covenant Health process and outcome measurement will be used. Organizational Access/Flow
Unit and Site Level Feedback Loops
Patient Satisfaction and Workforce Engagement Scores
How will we know if we are successful?
What supports are available to you?
Questions?