New strategy for Transitions of care:

I PASS IT ON

In pathology! By M&M

Definition of transitions of care

Challenges in Pathology

ACGME pathology milestones

Project Objectives

Project phases

Identification of points of TOCs in the Pathology department

New guidelines for effective TOCs

Poster Presentation at The United States and Canadian Academy of Pathology 2023

Future directions

Definition of transitions of care

Transitions of care (TOCs) or “hand-offs” are defined as changes in responsibility for the care of a patient.

The information communicated during a hand-off must be accurate to ensure safe and effective continuity of care. Several studies have shown that hand-offs are often variable and represent a major gap in safe patient care.

Challenges in Pathology

Transitions of care can be difficult to evaluate in pathology, as they are not easily identifiable or clearly defined:

• Currently there is not a significant amount of literature about the transitions of care that happen in pathology.

• There is no standardized way to evaluate transitions of care within the Department of Pathology.

• The increasing fragmentation of health care has the unintended consequence of more care transitions.

It is not easily apparent where and how hand-offs occur in a specialty like pathology, and it is imperative that we identify them in order to ensure safe and effective continuity of care.

ACGME pathology milestones

The Milestones provide a framework for the assessment of the development of the resident in key dimensions of the elements of physician competency in a specialty or subspecialty.

The Accreditation Council for Graduate Medical Education (ACGME) accredited residency programs use these Milestones in a semi-annual review of resident performance, and then report to the ACGME. Of note, the ACGME Pathology Milestones take into consideration the resident’s performance of safe and effective TOCs/hand-offs.

Milestones are arranged into levels. Tracking from Level 1 to Level 5 is synonymous with moving from novice to expert resident in the specialty or subspecialty.

Project Objectives

To improve transitions of care/hand-offs in pathology by:

• Identifying the points of hand-off.

• Evaluating the current hand-off process at these points.

• Applying/aligning the current processes with the institutional guidelines (IPASS the BATON).

• Developing an evaluation tool for hand-offs.

Project phases

The project is divided in three phases:

1.We surveyed faculty and trainees and developed our own guidelines specifically applied to pathology (I PASS IT ON).

2.Finally, we established new forms to track TOCs and are in the process of implementing them into our current workflow.

3.Formal evaluations to determine effective TOCs will be incorporated into New Innovations (NI).

Identification of points of TOCs in the Pathology department

We identified clear examples of TOCs: hand-offs of cases to another service in anatomic or clinical pathology and cases at end of blocks or before vacations, frozen section cases to the grossing bench, frozen sections after 5 pm and on-call issues.