Background: Transitions of care, including Inter-Hospital Transfers (IHT), are known to be a period of elevated risk in patient care. Patients who are transferred via the IHT process face a higher inpatient mortality rate than patients who are not admitted via the IHT process1 as well as higher costs, longer length of stay, and lower odds of discharge to home2. Despite these well-established complications that can arise from IHT and the frequency with which IHT occurs, there is no available literature about education on the IHT process. Given that IHT affects a wide variety of medicine patients, we felt strongly that all internal medicine housestaff should become comfortable triaging and managing patients in the IHT process as part of their training.
Purpose: To improve knowledge of, and confidence with, the best practices of the IHT process amongst internal medicine housestaff.
Description: The night float medicine resident was initially incorporated into the IHT transfer calls at night for purposes of handoff and communication. We recognized that this could be an ideal opportunity to provide education surrounding the IHT process. As such, we developed a brief but informative curriculum on the IHT process. The educational intervention consists of several components. Firstly, the night resident participates in all IHT transfer calls This opportunity allows the resident to actively participate in the call, with the hospitalist available as back-up if issues arise or further clarification is needed, and then ultimately making a decision regarding acceptance of transfer. Second, the resident documents the conversation in a standardized template which itself was designed to highlight the most pertinent information. Thirdly, real-time feedback is given to the resident after the transfer call Additionally, we developed a standardized IHT educational tool which is taught at the beginning of each night float rotation. This interactive session involves a brief didactic portion. We start with a group discussion regarding prior instances in which IHT went poorly and the root causes behind that. We then proceed to discuss why a standardized process for IHT matters, what the best practices for IHT are, and information on the legal aspects of IHT. This is followed by a case based “role-playing” session. Scripts are provided and the residents learn through performance of common IHT scenarios, followed by learning points. Finally, during the second week of the rotation, residents meet with the hospitalist to discuss IHT’s from the prior week This reflective practice allows them the opportunity to review the IHT cases they have participated in and evaluate what went well and what, if anything, could be done differently in the future. So far, the curriculum has been well-received and sparked informative discussions. To evaluate the success of the curriculum more objectively, residents are sent a REDCap survey before and after their night float rotation (see Figure 1). This has been recognized by the IRB as exempt QI work and data collection has been in progress since August 2021.
Conclusions: This curricular intervention has demonstrated that it is feasible to design and implement an educational curriculum to improve knowledge of and confidence with IHT. This curriculum serves as an example as a way to propagate the implementation of best practices in regards to IHT through the education of future attending physicians.
