The Microtransition Adverse Event Sign-In/Sign-Out (MASS) Form: A Potential Solution to Communication Barriers for Outpatient Medical Appointments and Nonmedical Outings in Post-Acute and Long-Term Care.

Nonurgent outings, such as routine medical appointments or nonmedical (eg, recreational) outings, are common occurrences in skilled nursing facilities (SNFs) and assisted living communities (ALCs). These outings involve changes in location and custodial responsibility of the resident-similar to interfacility transitions of care (eg, admissions, discharges). Thus, these microtransitions in care carry similar risks as larger transitions (eg, falls, medication errors, other adverse events). However, unlike admissions/discharges, outpatient medical appointments and nonmedical outings receive less clinical and administrative attention. Communication about these outings is usually verbal because facilities often lack protocols for microtransition documentation. In this paper, we introduce the Microtransition Adverse event Sign-in/Sign-out (MASS) form, a tool to enhance screening, communication, and quality assurance and process improvement around microtransition-related adverse events. The form has 2 versions, one for lay escorts (eg, family members) and another for nonemergent medical transport personnel, reflecting differences in clinical skill level. The MASS system was piloted for 2 months in a 130-bed SNF. Escorts filled out the form after the outing was complete, with guidance from receptionists who were trained administering the MASS tool. The form may be adapted for SNFs or ALCs. The MASS system engages receptionists, van drivers, family members, and other trip escorts in the care process; by integrating these individuals into the care team in this way, the MASS system strengthens adverse event surveillance and enhances handoffs, while optimizing the limited staffing resources already available in facilities.