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BOOSTing (Better Outcomes by Optimizing Safe Transitions) Care Transitions implementation toolkit provides a wealth of materials to
help you optimize the discharge process at your institution.
The tools and approach are based on principles of quality improvement (QI), evidence-based medicine, as well as personal and institutional experiences.
Originally, the BOOST Implementation toolkit was developed in 2008 through support from the John A. Hartford Foundation and has been continued to be revised and improved over the years. In 2014, SHM developed a revised 2nd edition of the guide that incorporated the latest literature on transitions of care as well as the experiences of lessons learned from the Project BOOST mentoring program's mentors (faculty experts) and participating BOOST hospitals (more than 180 in US and Canada).
The Guide is laid out in a user-friendly, step by step method with explicit instructions and worksheets to help new sites engage with Project BOOST, build effective QI teams, and improve the care of their patients as they transition out of the hospital.
implementation toolkit will help you to:
Each section of this resource is described below.
The BOOSTing (Better Outcomes by Optimizing Safe Transitions) Care Transitions Implementation Toolkit is the online version of the Care Transitions Implementation Guide. The suggested approach is based on 8 essential elements for improving the discharge process.
The implementation toolkit will walk you through each step of designing, implementing and evaluating your intervention. We recommend that you go through each section, in the order presented in the yellow portion of the navigation bar at the top of each page. However, if you are already familiar with the content of a particular section, skip ahead.
The toolkit also includes a wealth of other resources, (within the blue portion of the navigation bar at the top of each page) including Educational Resources (review of key literature, teaching slide sets, patient education and more) and Clinical Tools. Finally, for a refresher on Quality Improvement basic principles, visit QI Basics.
Download and print the Care Transitions for Older Adults Implementation Guide entitled, A Guide for Effective Quality Improvement: BOOST: Better Outcomes by Optimizing Safe Transitions (portable version of the key elements of the BOOSTing Care Transitions implementation toolkit).
Set up your team for success. Use this section to:
Review the literature for transitions from the inpatient to outpatient care setting and identify related guidelines and core measures. Following, select (or tailor) a protocol or series of tools that is aligned with the scope and goals of your project.
Appreciate care delivery as a series of intermediate and interdependent steps leading to the care endpoint of interest.
Qualitative analysis: diagram care delivery to identify steps in care transitions that may be unnecessary or may contribute to non-value-added variation in practice. Likewise, identify areas that are either missing or need important redundancy.
Quantitative analysis: analyze outcomes of discharge processes in a way that your project team can react to effectively.
Collect data needed to track performance on key metrics. Plot and report data graphically using a run chart. Write an aim statement to clearly identify what your team has targeted to improve. Consider tracking balancing measures, so that improvement in one area is not accompanied by a decrease in performance in another area.
The BOOST intervention suggests core metrics for improvement and provides a set of tools that can be used in their entirety, or modified to meet a site’s specific needs. Utilizing the BOOST approach you can:
Learn by testing and refining change in the clinical setting. Revise the protocols and order sets to embrace appropriate variation. Take steps to weed out inappropriate variation. Spread your improvements to other units.
1 Coleman, E, Parry, C, et, al. The care transitions intervention: a patient-centered approach to ensuring effective transfers between sites of geriatric care.
2 Simon, SR, Lee, TH, et, al. Communication problems for patients hospitalized with chest pain.
3 van Walraven, c, Mamdani, M, et, al. Continuity of care and patient outcomes after hospital discharge.
4 Preen D, Bailey B, Wright A, et al. Effects of a multidisciplinary, post-discharge continuance of care intervention on quality of life, discharge satisfaction, and hospital length of stay: a randomized controlled trial.
5 Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care.
6 Kripalani S, Jackson AT, Schnipper JL, Coleman EA. Promoting effective transitions of care at hospital discharge: A review of key issues for hospitalists.
between care providers is an essential part of medical care that
influences patients' quality of life and effective disease treatment.
Hospitalists can act as leaders to educate both patients and providers
regarding appropriate steps to take to improve care transitions, and
reduce risks associated with these transitions.