Background: The transfer of patients between hospitals (interhospital transfer, IHT), exposes patients to risks of discontinuity of care, such as errors in communication and gaps in information transfer. In our prior work evaluating IHT to general medical (GMS), cardiology, oncology and ICU services at an 800-bed tertiary care referral hospital, we found that in 37% of patient transfers, the quality of information available to admitting clinicians at time of IHT was “Poor” or “Fair,” resulting in delays in care in 12% of patients. Improving the availability of essential clinical information for IHT patients at the time of transfer is therefore vital to improving care provided to IHT patients.
Purpose: To use multidisciplinary stakeholder input to design and implement a standardized transfer accept note to improve access to essential clinical information during IHT.
Description: Over the course of 9 months (September 2020-June 2021), we engaged a group of key stakeholders in IHT at our hospital, including: (1) Medicine residents and physician assistants responsible for admitting IHT patients at time of arrival; (2) Attending medicine physicians responsible for accepting IHT patients for transfer; and (3) Frontline nurses and leadership within our hospital’s “Access Center” responsible for documentation of clinical information at time of IHT patient acceptance. Collectively, this stakeholder group created a process map to identify barriers to clinical documentation and identified most essential clinical information to include within a transfer accept note (e.g., from admitting clinician and accepting physician perspective), and feasibility of its documentation (e.g., from Access center nursing perspective). Based on this, a standardized transfer accept note template was created utilizing IPASS format (Illness severity, Patient summary, Action items, Situational awareness, Synthesis by receiver), given clinician familiarity and use of IPASS among other care transitions within our hospital. The IPASS transfer accept note was iteratively refined with stakeholder group input, converted into a “dot-phrase” (e.g., templated note within EPIC electronic health record), and implemented for use by Access Center nurses for all patient transfers to GMS and cardiology services in July 2021 (Figure). After a 1-month wash-in period, data on frequency of IPASS transfer note documentation was collected on 281 patient transfers to GMS and cardiology between August, 2021-November, 2021. We found that the IPASS transfer accept note was documented in 225 (80%) of patient transfers. Qualitative and quantitative measurement of impact of this intervention on quality of clinical information available at time of transfer, and on rates of medical errors after transfer is ongoing.
Conclusions: Multidisciplinary stakeholder creation and implementation of an IPASS transfer accept note among GMS and cardiology patient transfers resulted in 80% availability of the accept note at time of IHT patient arrival. Qualitative and quantitative data collection continues to evaluate impact of this intervention on quality of information available and rates of medical errors. Next steps include expansion of use of the IPASS transfer accept note to IHT to other services (planned expansion to all services in December, 2021) and ongoing measurement of impact.
