Tracers: They’re not just for accreditation surveys
Use methodology for ED process improvement
Since the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) began using tracer methodology as part of its survey process, ED managers have felt the necessity to perform their own tracers in preparation for these periodic visits. In so doing, however, they have learned that tracers can become, in and of themselves, valuable tools for improving processes in the ED.
Likened by some to a safety walk around, a tracer review involves following a selected patient through the entire continuum of care. As the door to the hospital, the ED is by necessity involved in many JCAHO tracers.
“The ED probably will be involved in 50% or more of all tracers here based on the percentage of our patients who come into the hospital through the ED,” says Deb Richey, MPA, director of emergency services at Parkview Hospital in Fort Wayne, IN.
Judy Homa-Lowry, RN, MS, president of Homa-Lowry Healthcare Consulting of Metamora, MI, says she always conducts tracers involving the ED because a number of care processes are tied to that department.
“We will look at appropriateness of triage, whether patients are treated in a timely manner, and how the handoffs are conducted,” Homa-Lowry says. “If the patient is in the ED for a period of time and then transferred to an admitting physician, we will look at how long it takes before the admitting physician takes over and has ownership of the patient.”
Parkview was just accredited by the Joint Commission for its stroke program, and tracer methodology was used for that survey process, Richey says. However, the tracer process also was used early last spring in a mock survey as part of the ED’s preparation, she says.
Tracers now play an important role in process improvement in the Parkview ED, Richey explains. They take a service-line approach, she adds.
“We’re now doing a lot of process improvement on acute MI patients, and we will do tracers on them to see if the staff understand the new process and how it works,” Richey says. “They also would be good for pneumonia, and on all core measures, to see how well the staff understand the pathways you’ve put in place.”
ED reaps benefits
In preparing for the Joint Commission survey on its stroke program, the Parkview ED was assessed as part of a tracer.
“We looked at what information was sent to the ambulance, how quickly it took our team to respond, how we communicated with the CT department, how critical results were communicated back to the ED, which physician was notified and how we documented that process, and so forth,” Richey says. “Basically, we looked at all of the processes and determined out how efficient they were.”
Richey says she is convinced that led to process improvement. “One of the managers involved in the stroke certification process would go through the ED every week after that and pretend to do a tracer,” she recalls. “That helped us teach the staff to think about all these pieces of the process.”
Areas targeted for improvement included the critical results policy, which was reinforced with staff, and the paging system. The rounding nurses were having difficulty receiving their pages. As it turned out, the phone number in the paging system for the rounding nurse was incorrect.
The paging system was updated, and the problem was resolved. In terms of critical results, improvement was needed in the documentation of who the information was relayed to and at what time. Audits are being conducted periodically to ensure compliance.
“We also identified places where there were lengthy delays to treatment and whether they were due, for example, to educational issues or to transfer issues,” Richey explains.
Over the past several years, JCAHO has focused more on how the patient proceeds through the system, Richey notes.
“It’s the method they use to assess us, so it can also become a way for us to assess our organization against their standards, and educate our staff so they are familiar with the methodology when the surveyor comes and asks questions,” she says. “Tracers help keep them familiar with the terminology, so if you do have a survey, it’s not so foreign to them.”
Be prepared
With Joint Commission surveys soon to be unannounced, this ongoing preparation becomes even more important. What will surveyors be looking for when they conduct tracers?
“First, they will want to look at the scope of what you do in the emergency room — what you are equipped to do and what you normally do,” Homa-Lowry adds. “What tracer methodology is going to do is evaluate their written procedures and how well they adhere to them.”
Thus, when she prepares clients’ EDs, Homa-Lowry evaluates what staff members say, what they do, and what’s in writing. “We look for inconsistency,” she says. “This is not just a JCAHO issue, but a potential risk management issue.”
Sources
For more information on tracer methodology, contact:
- Judy Homa-Lowry, RN, MS, President, Homa-Lowry Healthcare Consulting, 760 W. Sutton Road, Metamora, MI 48455. Phone: (810) 245-1535. E-mail: [email protected].
- Deb Richey, MPA, Director of Emergency Services, Parkview Hospital, 2200 Randalia Ave., Fort Wayne, IN 46805. Phone: (260) 373-6040. E-mail: [email protected].
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