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Enhanced Communication for Interhospital Transfers Increases Preparedness in an Academic Tertiary Care Center
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.
Keywordselectronic 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.
Received: 24 April 2022
Accepted: 21 July 2022
Article published online:
31 August 2022
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