Implementation of a Transfer Intervention Procedure (TIP) to improve handovers from hospital to home: interrupted time series analysis

Rosanne van Seben; Suzanne E Geerlings; Kim J M Verhaegh; Carina G J M Hilders; Bianca M Buurman

doi:10.1186/s12913-016-1730-x

Implementation of a Transfer Intervention Procedure (TIP) to improve handovers from hospital to home: interrupted time series analysis

BMC Health Serv Res. 2016 Sep 7;16(1):479. doi: 10.1186/s12913-016-1730-x.

Authors

Rosanne van Seben¹, Suzanne E Geerlings², Kim J M Verhaegh³, Carina G J M Hilders⁴, Bianca M Buurman^{3

5}

Affiliations

¹ Department of Internal Medicine, Division of Geriatric Medicine, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. r.vanseben@amc.uva.nl.
² Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
³ Department of Internal Medicine, Division of Geriatric Medicine, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
⁴ Reinier de Graaf Hospital, Reinier de Graafweg 5, PO Box 5011, 2600 GA, Delft, Netherlands.
⁵ ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD, Amsterdam, The Netherlands.

Abstract

Background: Accurate and timely patient handovers from hospital to other health care settings are essential in order to provide high quality of care and to ensure patient safety. We aim to investigate the effect of a comprehensive discharge bundle, the Transfer Intervention Procedure (TIP), on the time between discharge and the time when the medical, medication and nursing handovers are sent to the next health care provider. Our goal is to reduce this time to 24 h after hospital discharge. Secondary outcomes are length of hospital stay and unplanned readmission within 30 days rates.

Methods: The current study is set to implement the TIP, a structured discharge process for all patients admitted to the hospital, with the purpose to provide a safe, reliable and accurate discharge process. Eight hospitals in the Netherlands will implement the TIP on one internal medicine and one surgical ward. An interrupted time series (ITS) analysis, with pre-defined pre and post intervention periods, will be conducted. Patients over the age of 18 admitted for more than 48 h to the participating wards are eligible for inclusion. At least 1000 patients will be included in both the pre-implementation and post-implementation group. The primary outcome is the number of medical, medication and nursing handovers being sent within 24 h after discharge. Secondary outcomes are length of hospital stay and unplanned readmission within 30 days. With regard to potential confounders, data will be collected on patient's characteristics and information regarding the hospitalization. We will use segmented regression methods for analyzing the data, which allows assessing how much TIP changed the outcomes of interest immediately and over time.

Discussion: This study protocol describes the implementation of TIP, which provides the foundation for a safe, reliable and accurate discharge process. If effective, nationwide implementation of the discharge bundle may result from this study protocol.

Trial registration: Dutch Trial Registry: NTR5951.

Keywords: Discharge bundle; Hospitals; Implementation; Interrupted time series; Patient handovers.

MeSH terms

Humans
Internal Medicine
Interrupted Time Series Analysis*
Length of Stay
Netherlands / epidemiology
Patient Discharge
Patient Handoff* / organization & administration
Patient Handoff* / standards
Patient Safety / standards*
Quality of Health Care / standards*
Regression Analysis

Associated data

NTR/NTR5951