Collaboration as a Passport to Older Adult Safety

It could be the beginning of a joke: A nurse and an engineer walk into an emergency department.

In reality, it’s a powerful partnership for healthcare innovations.

Nicole Werner

“If you want to design something that’s actually going to work for different healthcare settings, you need to work with nurses,” says Nicole Werner, PhD, an assistant professor in the University of Wisconsin–Madison Department of Industrial and Systems Engineering.

“Nursing faculty bring clinical knowledge and patient advocacy, along with research expertise,” says Werner. “My nursing colleagues help me understand what something really means for a patient and their family.”

“Nurses bring an understanding of the day-to-day and moment-to-moment delivery of care,” agrees UW–Madison School of Nursing Associate Professor Barbara King, PhD, APRN-BC, FAAN, who collaborates with Werner and other engineering faculty.

“Engineers think about the mechanics of processes and how to design changes,” says King, “so that even something as complex as our healthcare system can run more smoothly and safer for our patients.”

King and Werner are part of a larger team working to develop a patient safety passport.

Led by the Wisconsin Institute for Healthcare Systems Engineering and faculty Pascale Carayon, PhD and Maureen Smith, MD, MPH, PhD, the four-year project involves the College of Engineering, School of Nursing, School of Medicine and Public Health, School of Pharmacy and UW Health. The goal is for the passport to help older adults avoid complications and accidents, as they transition between healthcare providers and care settings.

“Care transitions are very vulnerable points,” says Werner.

In the U.S., more than 20 million older people visit emergency departments each year. What happens next—and how it happens—can affect their health and independence.

“From the emergency department, older adults might get admitted to the hospital,” says Werner. “Or they might go to a skilled nursing facility. Or they might go home. Each of those transitions requires different information and types of communication.”

Poor communication during care transitions can increase older people’s risk of falls, medication errors, infections or blood clots, among other problems.

“Our idea is to create a patient safety passport that follows the person,” says Werner. “It could have information for patients, their families and the clinicians caring for them in different settings. It could detect errors—like missing information, or wrong or inappropriate medications—in time to recover from those errors. It could also be used to anticipate patient safety issues at the next care setting.”

The Systems Engineering Initiative for Patient Safety (SEIPS) is based on the Balance Theory of Job Design (Smith and Carayon, 1989, 1995; Carayon and Smith, 2000)

Researchers are now collecting and analyzing data, before designing the passport. One group is looking at patient data, to see how care transitions are connected to specific safety issues. Another group, led by Werner, is interviewing people in emergency departments, skilled nursing facilities and hospitals to better understand decision-making and other aspects of care transitions.

From her previous research, Werner knows that care transitions take longer than many people think.

“Transitions do not end at discharge,” says Werner. “It can take weeks or months for the people involved to feel like they’ve made it through the transition. We call that the patient journey. It’s longer, involves lots of players and can get really complex.”

To make things even more complicated, clinicians generally don’t have information about an important care setting: the patient’s home.

“We need to think about the home more,” says Werner. “Providers who are discharging patients are often asking them to do things that are really hard. Patients and their families may not have the resources, or may not know how or be able to implement care plans. We need to better identify what it’s like outside of formal healthcare settings and integrate that information into our care transition processes.”

That’s one reason why the project team will design the patient safety passport with input from older patients and their families, along with healthcare professionals.

“There are so many different players,” says Werner. “I see the engineering perspective as what holds it all together. I think more about systems and how they’re interacting. Nurses connect that to what it’s really going to look like in the real world.”

–Diane Farsetta