NR 527 Week 8 Collaboration Case Report Example

Collaboration Case Report: Did the Five-Facility Transfer Group Actually Work? A Verdict Located in Its Records, Not in How Its Members Felt

Student Name

College of Nursing, Chamberlain University

NR 527: Communication and Collaboration for Advanced Nursing Practice

Instructor Name

Month Day, Year

Collaboration Case Report: Did the Five-Facility Transfer Group Actually Work? A Verdict Located in Its Records, Not in How Its Members Felt

The Question and the Verdict

This report asks whether the collaboration between five nursing facilities and one emergency department, formalized as a transitions group with a written charter, achieved its purpose: that residents moving between the facilities and the department arrive with the information the next clinician needs to act. The verdict is mixed and specific. The collaboration worked for night returns from the emergency department to the facilities, which was the problem that started it. It did not yet work for daytime returns, for weekend returns, or for residents admitted to the hospital rather than returned. Each part of that verdict can be located in the group's records, and this report points to them.

The Starting Point

The work began with one resident, Mrs. B., who returned from the emergency department at 0145 with almost no paperwork and a newly prescribed antibiotic the night nurse could not have known about. That failure fits a pattern documented elsewhere: an audit of transfers into one emergency department found that most arrived missing something important (Cwinn et al., 2009), and staff on both sides have described residents moving in both directions without written documentation (Terrell & Miller, 2006). A conversation with the evening charge nurse led to a one-month trial of a four-line return sheet, and a memo to the medical director widened it, for three months, to every facility the department serves, and a charter set out how the group would run.

Where Success Is Located

The monthly reports. Across the three months of the extension, the reports show the proportion of night returns arriving with a completed return sheet rising from 64% in the first month to 78% in the second and 81% in the third, across all five facilities. Missed or delayed first doses of new medications on night returns, counted by each facility, fell from seven in the month before the extension to two in the third month. These are the group's own counts, not a controlled study, and the numbers are small. But they are recorded monthly, by named people, in documents anyone in the group can check.

The minutes of month two. When the evening charge nurse went on two weeks' leave, the charter's coverage rule named the physician in charge as the contact for urgent questions. The minutes record that facility nurses called on four occasions during those weeks and received answers within the agreed 30 minutes. The rule, written before it was needed, worked when it was needed. Research on teams suggests that settling such matters at a team's start, together with good strategies for the work, supports sustained performance (Mathieu & Rapp, 2009).

Where Failure Is Located

The weekend gap. The facility reports show that 11 of the 14 returns without a sheet in month three occurred on weekends, all during the day. The emergency department's weekend day nurses had not been told about the sheet; the medical director's message had gone to the evening and night staff only. That failure is located in a single email distribution list, and it was fixable once found.

Admissions. The group's records contain no data on residents admitted to the hospital, because the return sheet covers only returns from the emergency department. Hospital discharge summaries to the facilities, the subject of the mobility mismatch that nearly led to a fall, remain outside the group's work. The hospital case manager attended only one of three meetings. The absence of data is itself the finding: the collaboration has not reached the transition where information is most detailed and most at risk of being misread.

The direction of travel. The group improved what comes back to the facilities. It did not measure what goes to the department. Whether the facilities' handovers improved is unknown, because no one was assigned to count.

What Made the Difference

The records suggest three reasons the night-return work succeeded. It started with one specific, shared failure, which made it hard for anyone to dismiss. It asked for something small and cheap before asking for anything large. And it gave every task an owner and every channel an answer time, so that problems could be traced to a place in the process rather than to a person. Structured communication helps most when both sender and receiver know the format and where to find it (Haig et al., 2006), and the charter made that explicit. The collaboration also reflected the national interprofessional competencies in a practical way: members learned what the other organizations could and could not do, such as the fact that facility night nurses had no access to the hospital record, and designed around those limits (Interprofessional Education Collaborative, 2023).

What Comes Next

Three changes follow directly from the records. The medical director's message will be resent to all emergency nursing staff, including weekend day shifts, and the sheet will be required for all returns, not only night returns. The hospital case manager will be asked to name a backup, and the group will add one measure for admissions: whether the hospital discharge summary states the resident's level of assistance for walking. And each facility will count, for one month, whether its own transfer handovers include baseline function and goals of care, so that the group can see its own side of the exchange. Quality improvement programs for nursing homes have combined tools for communication with tools for recognizing and managing changes in condition (Ouslander et al., 2011); the group's next stage is to look at its own contribution as well as the department's.

Conclusion

The collaboration worked where its records show it working: night returns, a covered absence, falling missed doses. It failed where its records show gaps: weekends, admissions and the facilities' own handovers. Members' feelings about the group are warm, but warmth is not the evidence. The documents are, and they tell the group exactly where to go next, and in what order, beginning with the weekend shifts.

The group intends to write its next report against the same standard: numbers from its own records, named failure points and the specific change each one calls for. A collaboration judged this way can keep improving, because it always knows where it last fell short.

References

Cwinn, M. A., Forster, A. J., Cwinn, A. A., Hebert, G., Calder, L., & Stiell, I. G. (2009). Prevalence of information gaps for seniors transferred from nursing homes to the emergency department. CJEM, 11(5), 462-472. https://doi.org/10.1017/S1481803500011660

Haig, K. M., Sutton, S., & Whittington, J. (2006). SBAR: A shared mental model for improving communication between clinicians. Joint Commission Journal on Quality and Patient Safety, 32(3), 167-175. https://doi.org/10.1016/S1553-7250(06)32022-3

Interprofessional Education Collaborative. (2023). IPEC core competencies for interprofessional collaborative practice: Version 3. https://www.ipecollaborative.org/ipec-core-competencies

Mathieu, J. E., & Rapp, T. L. (2009). Laying the foundation for successful team performance trajectories: The roles of team charters and performance strategies. Journal of Applied Psychology, 94(1), 90-103. https://doi.org/10.1037/a0013257

Ouslander, J. G., Lamb, G., Tappen, R., Herndon, L., Diaz, S., Roos, B. A., Grabowski, D. C., & Bonner, A. (2011). Interventions to reduce hospitalizations from nursing homes: Evaluation of the INTERACT II collaborative quality improvement project. Journal of the American Geriatrics Society, 59(4), 745-753. https://doi.org/10.1111/j.1532-5415.2011.03333.x

Terrell, K. M., & Miller, D. K. (2006). Challenges in transitional care between nursing homes and emergency departments. Journal of the American Medical Directors Association, 7(8), 499-505. https://doi.org/10.1016/j.jamda.2006.03.004