Background:
Transitions of care have become more frequent as our health care system becomes more complex. In addition, the communication of clinical patient information across the continuum of care is variable and nonstandardized and can often be inadequate. Although there is a growing body of evidence about handoff communication, one area that has not been a significant focus of research is the relay of patient information when a patient is transferred from an acute care hospital to a tertiary‐care center. Our large inner‐city tertiary‐care hospital receives approximately 10,000 interhospital transfer patients annually, and although these patients are sent with a discharge packet, the quality of information is variable. When transfer documentation is incomplete or inaccurate, it often results in the need to obtain clinically relevant information that was not sent from the transferring facility and the likely duplication of studies, which can be frustrating for the receiving physician and delay patient care. The objective of this study was to assess the impact of the quality of interhospital transfer documentation on hospital cost in a tertiary care center.
Methods:
This study was an observational single‐center study that took place over 10 months and focused on patients transferred to a tertiary‐care center from other acute care hospitals. Patients were transferred to a medical floor, and excluded from the study were those requiring a higher level of care. The adequacy of transfer documentation was assessed with a 2‐part survey that was completed by the physician caring for the transferred patient. The survey questions related to the presence of transfer documentation, adequacy of information, and if time was spent obtaining records from the transferring facility. Completion of the survey was done by the medical teams and was voluntary. For the purposes of analysis, good documentation was defined as including an adequate discharge summary and medication list from the transferring facility. Additional information was then obtained using the hospital database which included length of stay, cost of hospitalization, severity of illness, and procedures and imaging performed.
Results:
Preliminary results from the first 63 surveys collected show that patients with inadequate transfer documentation have higher associated costs. On average, patients who are sent without adequate transfer documentation have an increased hospital cost of $28,000 compared with a similar patient with adequate documentation. Part of this cost is related to the need to repeat testing in order to provide timely care for the patient.
Conclusions:
When patients are transferred from an acute care hospital to a tertiary‐care center for continued care, the lack of complete and adequate documentation can result in increased cost and overutilization of health care resources.