Interim Care Mangement Strategies  

  Hematology-Oncology Section
Medicine Service
VA Ann Arbor Healthcare System
 
New tools for managing the care of patients between encounters are being developed and deployed. These include revision and enhancement of the "Blue Sheet" and addition of two new tools: TICKIT's and the patient's Care Plan "Fridge Note." These tools are summarized below.
 
 
Blue Sheet A tool for present action.
The Blue Sheet is the key document specifying actions to be taken as part of the clinic encounter and events planned for the future. Actions that require requisitions such as radiology, nuclear medicine, procedures, are ordered and scheduled by physicians. Consultations are ordered by physicians and typically scheduled by support staff, as are most outpatient appointments and laboratory studies. Accurate and thorough completion of the Blue Sheet efficiently communicates what has been done and what remains to be done.
 
TICKIT's A tool for future action.
TICKIT's are used to manage Tickler File Interim Tasks. The task planned is specified on the TICKIT which is placed in a tickler file for a target date. On that date, the appropriate person or role will handle the task and document briefly on the TICKIT, and if appropriate, in the electronic patient record. The TICKIT form serves as a requisition for handling of the specified task on the target date. At check-out the TICKIT is routed with the shadow chart. After clinic, copies of the TICKIT are made and filed in the tickler file. The original is kept with the shadow chart. On the target date, the TICKIT's for the day are pulled and handled. Notes and documentation of closure is made on the original and the copy may be discarded. All significant future actions should have an associated TICKIT; memory and verbal communication not acceptable substitutes for TICKIT's. The handlers of TICKIT's include physicians at all levels, nurses, and clerical staff.
 
Care Plan "Fridge Note" A tool for present and future events.
The patient's Care Plan "Fridge Note" is intended to help patients see the "big picture" of their care over time. It compliments rather than replaces other patient information. It focuses on the events of their care, not the supporting tasks delt with internally using the Blue Sheet and TICKIT's. The Care Plan should include all significant events from the patient's perspective, especially those that require adherence to instructions and appointments. Patient's should be strongly encouraged to post it in a prominent place, such as on their refrigerator and to refer to it often. It is hoped that this tool will help patients take greater responsibility for their care and decrease no-shows and dependency behaviors.
 

Please send comments to: kcease@umich.edu