Background: Outside-hospital (OSH) transfers are crucial to providing patients with a higher level or more specialized care. Despite the intent to improve care, OSH transfers are associated with negative outcomes due to miscommunication, lack of information, and other factors affecting patient care. Currently, there is no widely standardized process for OSH transfers. Studies show that standardized provision of key patient details improves outcomes. At our institution, a templated OSH transfer note (OSH note) significantly improved physician satisfaction and safety outcomes. However, nursing situational awareness and satisfaction remain unknown.
Purpose: Nurses are often the first members of the care team to see the patient upon arrival. Currently, there is insufficient exploration of the information nurses need to care for transfer patients. Once needs are established, it is important to provide access to the information necessary for safe OSH patient care.
Description: To address this gap, we conducted semi-structured interviews with 47 nurses from 7 units at Thomas Jefferson University Hospital (TJUH) between 6/14/24 and 6/28/24. Interviews covered information needs for a safe OSH transfer, the location of key details in the electronic health record (EHR), and opinions on current processes. Additional questions explored the usage of the OSH note and EHR transfer log. Responses were categorized into themes: information, transfer, timing, ambulance, or physician issues. Findings were reviewed with nursing leadership. The majority of nursing concerns could be addressed by ensuring awareness of and access to the OSH note or EHR transfer log. We implemented an educational intervention, beginning with a pre-survey of 100 nurses to assess current practices and perceptions of these resources. A two-minute instructional video on locating the OSH note and transfer log was distributed via email by unit-level leadership and through QR codes circulated in-person. Two months later, follow-up interviews with 33 nurses revealed limited engagement, with 2 nurses viewing the video and 1 applying it to their workflow. Post-survey responses (n=14) showed improvement, with 13 nurses reporting video usage and 9 utilizing the tools. The OSH note received an average usefulness rating of 4.1/5 and the transfer log 3.8/5.
Conclusions: While results are limited, there is promise that awareness and use of the OSH note and transfer log improve nursing care for OSH transfers. The low response rates to the educational video and surveys highlight dissemination challenges that need to be addressed. Future efforts will focus on enhancing engagement strategies and correlating process improvements with OSH patient outcomes