LAUSR

182 Background: The affiliate program at St. Jude Children’s Research Hospital (St. Jude) allows more children access to pediatric oncology care closer to the patient’s home. Currently 8 clinics, located throughout the Southeast and the Midwest, are affiliated with St. Jude and contribute 35% of patients enrolled in St. Jude clinical trials. Handoffs and transitions of care are common weak points in health care provider communication as patients move between sites. Failures in communication led to inefficiencies in care, patient dissatisfaction, and near-miss events. Ensuring that the information exchanged during the patient transition is efficient and complete will benefit patient safety and trust. With no consistent pattern of communication between St. Jude and affiliate clinics, we aimed to develop and implement a standardized communication tool to be used with each patient transition between different health care sites. Methods: Each team of providers (St. Jude and affiliate clinics) created individual flow diagrams to define the current state of communication when patients were transitioning between remote sites. Using fishbone diagrams each team identified the barriers to effective communication. Common barriers were incomplete communication and synthesis by the receiver. Results: We developed a communication bundle. Using IPASS methodology (a communication bundle developed for inpatient handoffs between resident physicians) we designed a standardized mnemonic, SMART (S-summary of plan; M-medications/roadmap; A-action plan; R-return visit date; T-transfer confirmation) for a patient transition between different health care sites. The communication bundle was transmitted by secure email. The time to send or receive the communication bundle was < 10 minutes. We measured % usage of the completed tool prior to transition, staff satisfaction, and number of errors. The SMART bundle was used 80% of the time and improved staff satisfaction. No errors have been identified. Conclusions: Closed loop, high-reliability communication can be accomplished between geographically remote health care sites using a standardized communication tool, which is transmitted electronically.