Interhospital transfer handoff practices among US tertiary care centers: A descriptive survey

Abstract

BACKGROUND Interhospital transfer is an understudied area within transitions of care. The process by which hospitals accept and transfer patients is not well described. National trends and best practices are unclear. OBJECTIVE To describe the demographics of large transfer centers, to identify common handoff practices, and to describe challenges and notable innovations involving the interhospital transfer handoff process. DESIGN AND PARTICIPANTS A convenience sample of 32 tertiary care centers in the United States was studied. Respondents were typically transfer center directors surveyed by phone. MAIN MEASURES Data regarding transfer center demographics, handoff communication practices, electronic infrastructure, and data sharing were obtained. RESULTS The median number of patients transferred each month per receiving institution was 700 (range, 250–2500); on average, 28% of these patients were transferred to an intensive care unit. Transfer protocols and practices varied by institution. Transfer center coordinators typically had a medical background (78%), and critical care–trained registered nurse was the most prevalent (38%). Common practices included: mandatory recorded 3-way physician-to-physician conversation (84%) and mandatory clinical status updates prior to patient arrival (81%). However, the timeline of clinical status updates was variable. Less frequent transfer practices included: electronic medical record (EMR) cross-talk availability and utilization (23%), real-time transfer center documentation accessibility in the EMR (32%), and referring center clinical documentation available prior to transport (29%). A number of innovative strategies to address challenges involving interhospital handoffs are reported. CONCLUSIONS Interhospital transfer practices vary widely amongst tertiary care centers. Practices that lead to improved patient handoffs and reduced medical errors need additional prospective evaluation.

Information handoff and outcomes of critically ill patients transferred between hospitals

“…In a large study of transfer centers, inter-hospital handoff processes varied widely. A verbal handoff was often recorded between providers, but concurrent documentation was rarely required[32]. …”

Interhospital Transfers: Managing Competing Priorities while Ensuring Patient Safety

“…The staff at each institution's "transfer center" then contacts key stakeholders (e.g., referring and accepting physician, bedside nurses, etc.) so that the receiving physician is fully aware of the patient's condition and any other information pertinent to the situation in order to determine the appropriateness of the proposed transfer, assess patient suitability for transfer in the context of available clinical data, allocate appropriate level-of-care resources (e.g., ICU bed, operating room), and finalize the decision on transfer modality (e.g., ground versus air transport) [41,42]. Not only is it necessary for the referring and accepting physicians to be in close contact and discuss the transfer and any potential challenges, but it is also critical for the nurses from the receiving and transferring facilities to communicate details of care pertaining to the patient [43,44].…”

“…This helps facilitate a smooth transition and minimizes any ITP-related disruptions. Lack of communication is a major, preventable source of medical error and is especially prevalent when the care teams are from two different facilities [41,44]. While distance, distractions, incongruent treatment goals/plans, uncertainty of timing, and contrasting information sources are all barriers to continuity of care, standardized medical handoffs can help reduce situational and informational confusion, reduce medical errors, and hopefully result in better and safer patient care [2].…”

“…In addition, patients should be transferred with readily available medical records, laboratory results, radiologic studies, and any other important documents needed to make optimal treatment decisions [41]. Whenever electronic access to patient record is feasible, the referring facility should enable appropriate viewing rights for authorized provider(s) at the receiving ISBAR:…”

Effect of a Handover Tool on Efficiency of Care and Mortality for Interhospital Transfers

“…This frequently precludes direct physician-to-physician contact at the time of transfer, and physicians rely on the discharge/transfer summary. 12 Yet discharge summaries are frequently absent or incomplete, 13 and often lack information for high-risk treatments such as systemic anticoagulation. 14 The traditional reliance on discharge summaries for handover communication requires interpretation of unstandardized documentation and increases the risk for miscommunication, delays, and error.…”