| Description |
Background: Transitions of care between inpatient and outpatient psychiatric settings for children and adolescents in foster care are often inadequate to ensure proper follow-up care. Gaps in communication regarding changes to medication and treatment plans have the potential to lead to patient harm. The lack of identified outpatient providers and/or changes in identified providers leads to further complications. Foster care children are a high-risk population that requires focused strategies to address continuity of care and medication management. Standardized hand-offs utilizing SBAR (situation, background, assessment, recommendation) communication is a potential solution to address these issues. The purpose of this project was to improve transitions of care between inpatient and outpatient settings for foster care children, by implementing a standardized SBAR hand-off and a process to increase the transmission of discharge summaries to outpatient providers and agencies. Methods: This quality improvement project used a survey to assess participants' familiarity, perceived role and responsibility, and overall perception with the transition process. A chart review was conducted to assess the transition process prior to implementation. A modified PSBAR (patient information, situation, background, assessment, and recommendation) tool and discharge process flowchart were developed and presented to participants during two educational presentations. The presentation included background data, chart review findings, and details relating to each intervention. Following a four-month evaluation period, a post-intervention survey was administered to determine the effectiveness and feasibility of both interventions and evaluate potential differences in participants' attitudes, perceptions, and overall satisfaction with the transition process. Results: Of the 17 foster children discharged during the evaluation period, only one (5.8%) mentioned an attempted hand-off with an identified outpatient provider. Reasons why hand-offs were not completed included the lack of an identified outpatient provider, provider changes due to new foster placement and location, and Division of Child and Family Services (DCFS)caseworkers unable to find placements and/or providers before discharge. There was a significant increase (p<0.001) in the percentage of discharge summaries sent to Fostering Healthy Children (FHC) during the evaluation period. Of the 17 discharge summaries, 14 (82.4%) were sent to agencies/providers, five (29.4%) were sent to DCFS, and nine (52.9%) were sent to FHC. The post-intervention survey found that only four (21.1%) indicated they were satisfied or very satisfied with the process post-intervention, and nine (47.4%) indicated they were still dissatisfied or very dissatisfied with the process. However, there was a significant difference (p<0.016) in participants' perception that sufficient resources were available to support standardized hand-offs in their work settings. Conclusions: There are specific and unique challenges to implementing standardized hand-offs within the foster care setting. The transmission of discharge summaries to outpatient providers/agencies, DCFS, and FHC is a feasible intervention that will improve transitions of care of foster children between psychiatric settings. However, there is a residual dissatisfaction with the overall transition process. Further work and collaboration should focus on the identification of outpatient providers early in the process, staff education, defining roles, and increased accountability of all those involved in the care of foster children. |
