Enhanced Communication for Interhospital Transfers Increases Preparedness in an Academic Tertiary Care Center

Abstract

Objectives This quality improvement project sought to enhance clinical information sharing for interhospital transfers to an inpatient hepatology service comprised of internal medicine resident frontline providers (housestaff) with the specific aims of making housestaff aware of 100% of incoming transfers and providing timely access to clinical summaries.

Interventions In February 2020, an email notification system to senior medicine residents responsible for patient triage shared planned arrival time for patients pending transfer. In July 2020, a clinical data repository (“Transfer Log”) updated daily by accepting providers (attending physicians and subspecialty fellows) became available to senior medicine residents responsible for triage.

Methods Likert scale surveys were administered to housestaff before email intervention (pre) and after transfer log intervention (post). The time from patient arrival to team assignment (TTA) in the electronic medical record was used as a proxy for time to patient assessment and was measured pre- and postinterventions; >2 hours to TTA was considered an extreme delay.

Results Housestaff reported frequency of access to clinical information as follows: preinterventions 4/31 (13%) sometimes/very often and 27/31 (87%) never/rarely; postinterventions 11/26 (42%) sometimes/very often and 15/26 (58%) never/rarely (p = 0.02). Preinterventions 12/39 (31%) felt “not at all prepared” versus 27/39 (69%) “somewhat” or “adequately”; postinterventions 2/24 (8%) felt “not at all prepared” versus 22/24 (92%) somewhat/adequately prepared (p = 0.06). There was a significant difference in mean TTA between pre- and posttransfer log groups (62 vs. 40 minutes, p = 0.01) and a significant reduction in patients with extreme delays in TTA post-email (18/180 pre-email vs. 7/174 post-email, p = 0.04).

Conclusion Early notification and increased access to clinical information were associated with better sense of preparedness for admitting housestaff, reduction in TTA, and reduced frequency of extreme delays in team assignment.

Keywords

electronic health records and systems - communication barriers - provider–provider - inpatient care - hospital information systems

Protection of Human and Animal Subjects

This project was reviewed and approved by the Mount Sinai Department of Medicine Quality Improvement Committee as a quality improvement, nonresearch project. It was therefore exempt from review by the Institutional Review Board.

Publication History

Received: 24 April 2022

Accepted: 21 July 2022

Article published online:
31 August 2022

• References

• 1 Agency for Healthcare Research and Quality. Healthcare cost and utilization project (HCUP). Rockville, MD: Agency for Healthcare Research and Quality; 2019
• 2 Mueller SK, Fiskio J, Schnipper J. Interhospital transfer: transfer processes and patient outcomes. J Hosp Med 2019; 14 (08) 486-491
• 3 Sokol-Hessner L, White AA, Davis KF, Herzig SJ, Hohmann SF. Interhospital transfer patients discharged by academic hospitalists and general internists: characteristics and outcomes. J Hosp Med 2016; 11 (04) 245-250
• 4 Reichheld A, Yang J, Sokol-Hessner L, Quinn G. Defining best practices for interhospital transfers. J Healthc Qual 2021; 43 (04) 214-224
• 5 Mueller S, Murray M, Schnipper J, Goralnick E. An initiative to improve advanced notification of inter-hospital transfers. Healthc (Amst) 2020; 8 (02) 100423
• 6 Mueller SK, Shannon E, Dalal A, Schnipper JL, Dykes P. Patient and physician experience with interhospital transfer: a qualitative study. J Patient Saf 2021; 17 (08) e752-e757
• 7 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
• 8 Harris PA, Taylor R, Minor BL. et al; REDCap Consortium. The REDCap consortium: building an international community of software platform partners. J Biomed Inform 2019; 95: 103208
• 9 Montalvo M, Patel RV, Sheth AM, Yoo EJ, D'Mello KF. Risk factors for unplanned intensive care unit transfer after inter-hospital transfer of medical patients. Poster presented at: American Thoracic Society International Conference; May 23, 2018; San Diego, CA
• 10 Santhosh L, Lyons PG, Rojas JC. et al. Characterising ICU-ward handoffs at three academic medical centres: process and perceptions. BMJ Qual Saf 2019; 28 (08) 627-634
• 11 Abraham J, King CR, Meng A. Ascertaining design requirements for postoperative care transition interventions. Appl Clin Inform 2021; 12 (01) 107-115
• 12 Wentworth L, Diggins J, Bartel D, Johnson M, Hale J, Gaines K. SBAR: electronic handoff tool for noncomplicated procedural patients. J Nurs Care Qual 2012; 27 (02) 125-131