Purpose: A standardized protocol for intrahospital transfers was created to facilitate exchange of information and allow for appropriate review by the accepting physician with subsequent coordination of care.
Description: The protocol (Figure 1) was implemented in May of 2015. All transfers to the hospitalist service were handled according to the protocol. Data collected by Emergency Medical Services (EMS) was reviewed prior to and after protocol implementation. We examined several outcomes including number of transfers per month, number of upgrades (from floor to higher level of care), number of rapid responses, number of deaths and Length of Stay Index.
Conclusions: LOSI improved (Figure 2) after implementation of a standardized transfer protocol (Figure 1). Pre-intervention (the period from January to April 2015), LOSI was 1.41. Post-intervention (the period from May 2015 – December 2015), LOSI was 0.99. The other outcomes examined including transfers/month, upgrades, rapid responses and death were relatively infrequent events and differences prior to and after protocol initiation were not significant. Prior studies are consistent with similar results regarding rapid responses, upgrades and deaths.
We feel that our results with standardizing the protocol for intrahospital medicine transfers show a clear benefit with regards to length of stay index and we hypothesize that adopting this as best practice for intrahospital transfers at other institutions would yield similar outcomes.