A taxonomy and cultural analysis of intra‐hospital patient transfers

Abstract

Existing research on intra-hospital patient transitions focuses chiefly on handoffs, or exchanges of information, between clinicians. Less is known about patient transfers within hospitals, which include but extend beyond the exchange of information. Using participant observations and interviews at a 1,541-bed, academic, tertiary medical center, we explored the ways in which staff define and understand patient transfers between units. We conducted observations of staff (n = 16) working in four hospital departments and interviewed staff (n = 29) involved in transfers to general medicine floors from either the Emergency Department or the Medical Intensive Care Unit between February and September 2015. The collected data allowed us to understand transfers in the context of several hospital cultural microsystems. Decisions were made through the lens of the specific unit identity to which staff felt they belonged; staff actively strategized to manage workload; and empty beds were treated as a scarce commodity. Staff concepts informed the development of a taxonomy of intra-hospital transfers that includes five categories of activity: disposition, or determining the right floor and bed for the patient; notification to sending and receiving staff of patient assignment, departure and arrival; preparation to send and receive the patient; communication between sending and receiving units; and coordination to ensure that transfer components occur in a timely and seamless manner. This taxonomy widens the study of intra-hospital patient transfers from a communication activity to a complex cultural phenomenon with several categories of activity and views them as part of multidimensional hospital culture, as constructed and understood by staff.

Inter‐shift handoff: Changes over a 6‐year interval

“…It has been suggested that handoffs should be studied at the minimum by unit type (Rikos, Linardakis, Economou, Rovithis, & Philalithis, 2019; Staggers & Blaz, 2013). Differences exist between unit cultures and job requirements (Rosenberg et al., 2018). For instance, the handoff is considered especially important and more challenging in the ICU, because of the critical nature of the patient's condition and inherent complexity thereof (Colvin, Eisen, & Gong, 2016).…”

“…ED nursing staff are likely to use various handoff strategies to compensate for their challenging environment (Venkatesh, Curley, Chang, & Liu, 2015). General ward nursing staff typically take care of less severely ill patients and see themselves as mainly providing patient‐centred care (Rosenberg et al., 2018). In this study, the unit‐specific results indicate that the surgery wards demonstrated the most significant improvement in information transfer.…”

Cooperation and conflict in intra‐hospital transfers: A qualitative analysis

“…While it is critical to understand the risks posed to patients during transfers, the impact of transfers on hospital staff from a wide array of professional backgrounds is less well-understood (Halvorson et al, 2016;Rosenberg et al, 2018). Research that acknowledges staff experiences in maintaining patient safety during intra-hospital transfers is needed to understand other factors that contribute to adverse events, delays in care and other risks to patients (Hearld, Alexander, Fraser, & Jiang, 2008).…”

“…Research that acknowledges staff experiences in maintaining patient safety during intra‐hospital transfers is needed to understand other factors that contribute to adverse events, delays in care and other risks to patients (Hearld, Alexander, Fraser, & Jiang, ). To this end, a quality improvement project using an ethnographic approach was conducted to examine the latent conditions that affected how multidisciplinary team members experienced intra‐hospital transfers from the Emergency Department and Medical Intensive Care Unit to General Internal Medicine floors at an urban teaching hospital (Rosenberg et al, ). Observations of and interviews with team members including clinicians (nurses, physicians and a physician's assistant) and support staff (unit clerks and bed managers and bed associates who assigned patients to beds) informed the development of a taxonomy of intra‐hospital transfers (Rosenberg et al, ).…”

“…To this end, a quality improvement project using an ethnographic approach was conducted to examine the latent conditions that affected how multidisciplinary team members experienced intra‐hospital transfers from the Emergency Department and Medical Intensive Care Unit to General Internal Medicine floors at an urban teaching hospital (Rosenberg et al, ). Observations of and interviews with team members including clinicians (nurses, physicians and a physician's assistant) and support staff (unit clerks and bed managers and bed associates who assigned patients to beds) informed the development of a taxonomy of intra‐hospital transfers (Rosenberg et al, ). Cooperation and conflict were two prominent codes that emerged from the primary analysis, leading the research team to suggest further study.…”