An initiative to improve advanced notification of inter-hospital transfers

Abstract

Poor communication during inter-hospital transfer (IHT, the transfer of patients between acute care hospitals) is common. Clinicians often report feeling unprepared to care for IHT patients due to inadequate advance notification. The aim of this project was to improve advance notification of general medicine service patient transfers to a tertiary care referral hospital. We used quality improvement principles to design and implement two interventions: (1) Use of a checklist; (2) Redesign role/responsibilities within the Access Center and Bed Control Department. Data on frequency of advance notification was collected over 9 months and plotted on a statistical process control chart with evaluation for special cause variation. We also evaluated barriers/facilitators to implementation and surveyed clinicians on information received with the advance notification. 103 patients underwent IHT during the study. Frequency of advance notification increased from a baseline of 63.6%-85.4% post-intervention. Several contributors to successful implementation were identified, including ensuring key stakeholder input and leveraging existing systems structure, among others. Survey results highlighted potential targets for future IHT improvements such as improved clinical information available to admitting clinicians in advance of patient transfer. In conclusion, we successfully improved advance notification of IHT, an essential step to improve communication. Next steps include sustainment and automation of these efforts and ongoing targeted process improvement efforts with an ultimate goal of improving patient outcomes during IHT.

Keywords: Care transitions; Communication; Interhospital transfer; Quality improvement.