Patient handover has repeatedly been considered an area of substantial vulnerability to patient safety. According to the Joint Commission on the Accreditation of Healthcare Organizations, 70% of all sentinel events have some element of communication failure. With 200,000 EDs/UCC visits and 25,000 discharges from our inpatient units annually at Niagara Health, the sheer volume of Transfer of Accountability points is substantial. Therefore, optimizing the handover processes can significantly mitigate risk and promote the safe exchange of information during care transitions.

Beginning in 2017, Niagara Health identified We TOA as a key strategic initiative to create a time-stamped, accountable, TOA procedure within a complex, multi-site, community health system. The Aim of the initiative is to develop structured approaches to improve the safe sharing and exchange of information between all of our healthcare providers and teams, especially during care transitions. We will collaborate with patients and their families as part of this process.

In order to effectively meet the needs of both medical and inter-professional providers, the initiative was structured in two phases with We TOA for Physicians launching in 2018, and We TOA for inter-professionals scheduled to launch in 2019. In order to effectively engage Physicians, a standardized communication tool was developed to document TOA electronically through Entry Point or by dictation using Dragon Front-End Technology. This new Physician Transfer of Accountability (PTOA) tool exists in addition to the current verbal TOA process.

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