A process of using electronic communication between hospital and municipality: SAM:BO

Why was this example implemented?

Experience shows that health care information and appointments are easily lost in the transition from one agency to another . Also, patients may have to spend more time in hospital than is necessary because coordinating care with the municipality after discharge is slowed by poor communication. There are clear gaps in the discharge process due to lack of coordination, information and documentation between different health providers.

The new Health Act of 2007 changed responsibilities for health service management to address these issues. The responsibility for the management of the transfer of information  was moved from the hospitals to the municipalities.The Health Act is concerned with the development of healthcare agreements between regions and municipalities and collaborations between hospitals and municipalities. SAM:BO is one such example of this type of agreement.

The target groups of the agreement are hospital professionals especially nurses and those employed by the municipality including nurses, nurse assistants, social workers and doctors, as well as the user and his family.

Description

SAM:BO is a collaborative agreement in the Region of Southern Denmark between four hospital areas and GPs and 22 municipalities. The purpose of the agreement is to achieve higher quality care and patient satisfaction with health care services. This is achieved through an agreed working arrangement and the use of an electronic tool for transferring patient information.The basic principles for SAM:BO are that:

• Patients’ care should be cohesive to achieve higher satisfaction.
• Efforts should be geared towards meeting patient needs.
• The discharge process should begin at admission.
• Consistency and flexibility can be achieved through good communitcation.
• Patients should be involved in planning their care.

Where patients are admitted to hospital for more than 24 hours, the following agreed protocol is followed:

• Within 24 hours of admission, if the patient receives services from the municipality then the hospital informs the municipality electronically using an agreed reporting form that the patient has been hospitalised. The municipality then returns a report to the hospital with information that they hold on the patient.
• Within 48 hours of admission, the hospital must send  an electronic interim report which contains the patient’s treatment plan and possible discharge date, if known.
• Within 8 hours after the interim report is sent the municipality sends an electronic receipt to the hospital which notifies the hospital of whether the discharge date has been accepted. The date may be refused if the municipality needs more time to coordinate care for the patient.
• If necessary, nurses from the municipality and the hospital can arrange a meeting at the hospital or in the patient’s home to coordinate the care plan. In these cases, the nurse from the hospital has overall responsibility for planning care and leads the meetings. It is expected that the patient and their family/relatives will attend the meeting.
• On the day of discharge, the hospital sends the care plan designed by the nurse, patient and family electronically to the municipality. At the same time an electronic medical discharge summary is sent to the general practitioner as well as an electronic hospital rehabilitation plan (if relevant).

To date, no cost analysis has been done on SAM:BO.

What are/were the effects?

In December 2010 the Center for Quality conducted an audit of SAM:BO.  It included 5 municipalities and 5 hospital departments and 100 patients (Report: SamBo audit CFK december 2010).

The audit looked at the quality of data captured in the electronic report which is sent from the municipality to hospital within 24 hours of hospital admission and the electronic care plan which is sent from the hospital to the municipality within 48 hours of admission. The focus of the audit was to look at the rate of completion of the various elements of the electronic form.

The audit showed that the municipalities in general shared information with the hospital regarding the patient’s personal information, general practitioner details, relatives, their municipality contact person, and housing arrangements. However,  they less often shared information about what aids the patient has and what medications they are on. The audit also found that insufficient information  was reported to the hospital about the extent of help with food and homecare that the patient requires, and their physical, mental and social condition.

The audit showed that the hospitals in general shared information regarding the patient’s  hospital contact person, department and preliminary diagnosis. However, the hospital shared information less often about the estimated date of discharge and estimated disability at discharge. In general there was insufficient information about estimated needs for care and rehabilitation needs after discharge.       

The audit was conducted by nurses from the hospital departments and  nurses from the municipalities. After the audit, they met and discussed the results. They assessed that one of the causes of the lack of shared information was that the deadline for sharing the information was too short (24 and 48 hours respectively).

A nationwide patient satisfaction survey is conducted regularly in Denmark, however, it is not possible to use the results of this survey to evaluate SAM:BO as it is not specific enough for this purpose. 

SAMBO has resulted in fewer treated patients needing to remain in hospital longer while waiting for the municipality to arrange care after discharge because the municipality is now better in delivering care services on time. In general SAM:BO has shown a decrease in the number of bed-days of hospitalised patients who are no longer in need of hospitalisation.

Concerning readmissions, SAM:BO indicates that readmissions are most often due to lack of municipality care service available.  However, the regions and the municipalities plan to investigate and study this issue further in the future.

The SAM:BO agreement continues to be evaluated by an organisation consisting of managers from hospitals and municipalities.

The agreement has strengthened the cooperation between hospitals and municipalities. The electronic method of transferring data is working and procedures are on track to be implemented on all hospital units and municipalities in the Region of Southern Denmark.

What are the strengths and limitations?

A number of strengths and opportunites have been identified:

• Efforts are geared to anticipate future patient needs.
• SAM:BO has clarified the roles and accountability regarding information flow and follow-up between health providers.
• Consistency in the content of information that is shared between hospitals and municipalities is ensured through the use of a standardised electronic form.
• Cooperation has been strengthened between the hospitals and the municipalities; the  electronic form that is used has been important in faciltating cooperation.
• It has been proposed that the agreement could be used to focus on the prevention of readmissions.

Despite these strengths, problems still exist with the transition of information between hospital departments and the municipality.

Recommendations based on the audit have been made to improve the operation of the agreement:

• More time should be allowed for collecting and disclosing of the relevant data.
• More meetings should be held between the patient, relatives, and health professionals from the hospital and municipality in order to plan care after discharge. 
• The use of  telemedicine should be expanded.
• Health professionals need to be more precise in describing the patient’s needs for care.

Credits

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