A Systematic Review of Clinical Outcomes Associated With Intrahospital Transitions

Abstract

Previous transitional care research has focused on transitions occurring between community and hospital settings. Little is known regarding intrahospital transitions and how they affect care quality. A systematic review was therefore conducted to synthesize the literature regarding clinical outcomes associated with intrahospital transitions. Literature published between January 2003 and December 2018 and indexed in Medline/PubMed, CINAHL, and PsychINFO were reviewed using PRISMA guidelines. Articles were limited to English language and peer-reviewed. Articles were excluded if they focused on transitions occurring from or to the hospital, discharge/discharge planning, or postdischarge follow-up. Data abstraction included study characteristics, sample characteristics, and reported clinical outcomes. Fourteen studies met inclusion criteria, primarily using cross-sectional, cohort, or retrospective chart review quantitative designs. Data were analyzed and synthesized based on outcomes reported. Major outcomes emerging from the articles included delirium, hospital length of stay, mortality, and adverse events. Delirium, hospital length of stay, and morbidity and mortality rates were associated with delayed transfers and transfers to inappropriate units. In addition, increased fall risk and infection rates were associated with higher rates of transfer. Intrahospital transitions represent critical periods of time where the quality of care being provided may be diminished, negatively affecting patient safety and outcomes.

Association between intrahospital transfers and hospital-acquired infection among elderly patients: A retrospective case-control study in one urban UK hospital trust

“…2 However, despite being established as an avenue for transmission of pathogens between hospitals, [9][10][11] there is still a lack of clarity around the relationship between intrahospital patient movement and the risk of HAI. 2,12 HAIs are defined as infections which have developed in a hospital or other healthcare delivery setting 48 hours or more following admission, or are present on day 1 or day 2 of admission in a patient discharged in the preceding 48 hours. 13 They place a significant burden on health systems worldwide and lead to increased mortality, intensive care unit (ICU) admissions and longer hospital spells.…”

“…Intrahospital transfers have been variously defined in the literature as any change of location a patient undergoes within the hospital, including transfers between the emergency department (ED) and an inpatient ward, a ward and a procedure room, or two beds on the same ward. 2 Clinical factors such as the need for a procedure or isolation due to infection may require transferring the patient. 3 However, minimal bed availability can also induce extra intrahospital transfers.…”

Healthcare-associated infections: where we came from and where we are headed

“…12 These transfers require a complex cascade of events and are affected by environmental control and communication challenges, professional conflicts related to variation in culture between units, hospital census and provider workload. 13 In a systematic review, Bristol and colleagues found that intrahospital transfers are frequently associated with adverse outcomes, such as delirium, increased risk of falls, increased length of stay and prolonged duration of mechanical ventilation and central venous catheterisation. 13 This therefore further highlights the significance of intrahospital transfers on patient outcomes.…”

“…13 In a systematic review, Bristol and colleagues found that intrahospital transfers are frequently associated with adverse outcomes, such as delirium, increased risk of falls, increased length of stay and prolonged duration of mechanical ventilation and central venous catheterisation. 13 This therefore further highlights the significance of intrahospital transfers on patient outcomes.…”

“…Prior studies have identified that patients experience an average of 2.4 transfers during a hospitalisation and approximately 96% of individuals experience a transfer during hospitalisation. 13 Transfers within the hospital also affect patient care and safety in other ways, resulting in delays in diagnosis and treatment due, in part, to poor coordination of care and inadequate handoffs between units. 19 Additionally, intrahospital transfers take an average of 1 hour to complete, adding significantly to nursing workload.…”