Background: Most medical centers have limited ICU beds to directly admit high acuity patients from the emergency department. This is compounded by the trend towards increased medical acuity. Thus, rising numbers of patients with higher acuity are being admitted to general medical units and later requiring transfer to ICU. These patients have higher in-hospital mortality […]

Background: With the recent consolidation of hospital systems and the increasing complexity of inpatient care, receiving inter-hospital transfers (IHT) has become more common for large academic medical centers. Notably, studies have shown IHT to be associated with increased length of hospital stay (1,2), increased cost of care (2,3), as well as delays in care and […]

Background: Outside hospital (OSH) transfer processes vary across institutions. The fragmented and complex nature of OSH transfers pose patient safety risks. A recent implementation of a standardized OSH transfer process with templated note for hospital medicine patients at our institution demonstrated promising patient safety outcomes and a significant increase in physician satisfaction. This pilot study […]

Background: The transfer of patients between hospitals, known as inter-hospital transfer (IHT), is associated with higher rates of mortality, longer lengths of stay, and higher hospitalization costs compared to admissions from the emergency department. Despite these poor patient outcomes, best practices to guide IHTs are lacking. To characterize the IHT process and identify key challenges […]

Background: Interhospital transfer (IHT) is intended to improve access to specialized therapies, maintain continuity of care, or care concordant with patients’ wishes; however, it is correlated with higher costs, longer length of stay, and greater mortality for many patients, even after illness severity adjustment (1-5). A better understanding of frontline providers’ reasons to accept transfer […]

Background: Boarding of admitted patients in the Emergency Department has become an increasingly large problem throughout the country. Longer boarding times are associated with a wide range of adverse effects, ranging from patient discomfort to medical errors and death. Emergency Departments are not designed to provide inpatient care and require frequent diversion of attention and […]

Background: Inter-hospital transfers are integral to a functioning health care network. Critical access, rural, and community hospitals established in sparsely populated territories are unable to support tertiary care infrastructure and rely on academic centers for consultation and transfer. Transfers comprise an estimated 3.5% of inpatient admissions (1), owing in part to increased procedural specialization concentrated […]