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Project BOOST - Better Outcomes by Optimizing Safe Transitions

Project BOOST® Implementation Toolkit

The 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.

BOOST Home Page BOOST Implementation Guide

This implementation toolkit will help you to:

  • Analyze current workflow processes
  • Select effective interventions
  • Redesign work flow and implement interventions
  • Educate your team on best practices
  • Promote a team approach to safe and effective discharges
  • Evaluate your progress and modify your interventions accordingly 

Each section of this resource is described below. 

How to Use:

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.

Implementation Guide:

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).

First Steps:

Set up your team for success. Use this section to:

  • Survey previous or ongoing efforts and resources.
  • Clarify key stakeholders, reporting hierarchy, and approval process.
  • Obtain support and approval from the institution.
  • Assemble an effective multidisciplinary team.
  • Set general goals and a timeline.
  • Turn general goals into specific goals.
  • Follow a framework for improvement.

Best Practices:

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.

Analyze Care Delivery:

Appreciate care delivery as a series of intermediate and interdependent steps leading to the care endpoint of interest.

  • Diagram your current care delivery processes.
  • Identify interrelated steps and failure modes.
  • Identify steps that should become targets for improvement efforts.
  • Select metrics for evaluating key components of your program including patient/family caregiver preparedness, medication safety, follow-up care, and the discharge education process.

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.

Track Performance:

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.

  • Key metric #1: Care Transitions Outcome Measures such as readmission rates, Average LOS, and Patient Satisfaction.
  • Key metric #2: Care Transitions Process Measures such as how well are patients prepared for discharge or caregivers prepared in caring for the patient post-discharge, what proportion of follow-up clinicians receive communication regarding the patient’s hospitalization and follow-up issues at time of discharge.
  • Data collection.
  • Data reporting using run charts.

The BOOST Intervention:

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:

  • Identify guidelines and core measures that will guide your care transitions project and redefine your processes.
  • Select clinical tools to support an optimized discharge process.
  • Create and support a team approach to an optimized discharge process.
  • Identify patients at risk for readmission or other poor post-discharge outcomes.
  • Prepare patients and families for the discharge transition. Utilize the teach-back process to ensure they understand care plans, self-care instructions, and follow-up appointments.
  • Communicate key information with receiving physicians.
  • Raise performance incrementally.

Continue to Improve:

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.

  • Learning in the clinical setting: Plan-Do-Study-Act.
  • Spreading improvement to other units.

Why Should You Act?Click to expand

  • Hospitalists, by definition, introduce discontinuity in care as patients transition from outpatient provider, to the hospital medicine service, and then back to outpatient provider.
  • Inadequately performed care transition can lead to multiple negative consequences such as decreased patient understanding, medication errors, increased stress on the caregiver, increased readmission rates, and an increase in care costs.
  • Collaboration between health care providers has been shown to improve these outcomes, as well as patient satisfaction and quality of life.

Coleman, E, Parry, C, et, al.  The care transitions intervention: a patient-centered approach to ensuring effective transfers between sites of geriatric care.

Home Health Care Serv Q 2003; 22(3):1-17. PMID: 14629081

Simon, SR, Lee, TH, et, al.   Communication problems for patients hospitalized with chest pain.

J Gen Intern Med. 1998 Dec;13(12):836-8.   PMID: 9844081

van Walraven, c, Mamdani, M, et, al.   Continuity of care and patient outcomes after hospital discharge.

J Gen Intern Med. 2004 Jun;19(6):624-31.   PMID: 15209600

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.

Int J Qual Health Care. 2005; Feb 17(1):43-51.   PMID: 15668310

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.

JAMA 2007; 297:831-41. PMID: 17327525

Kripalani S, Jackson AT, Schnipper JL, Coleman EA.   Promoting effective transitions of care at hospital discharge: A review of key issues for hospitalists.

J Hosp Med 2008;2:314-323.   PMID: 17935242


Fundamental Principle for Care Transitions

Communication 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.

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BOOSTing Care Transitions implementation toolkit Project Team
This first edition of the BOOST implementation toolkit was sponsored in part by an unrestricted educational grant from the John A. Hartford Foundation, Inc. SHM updated the second edition workbook in 2014.
The implementation toolkit is an online resource for visitors to the Society of Hospital Medicine's website. All content and links have been reviewed by the BOOST Project Team, however the Society of Hospital Medicine does not exercise any editorial control over content associated with the external links that have been made available via this website.