Background: The Institute for Healthcare Improvement tells us that successful discharge planning starts at admission; however, when that admission occurs to a closed Intensive Care Unit (ICU), traditional discharge planning can be delayed until the patient transfers to a general floor. This delay can be exacerbated as a hospital’s adult medical-surgical bed occupancy rises, increasing [...]

Background: Approximately 1.6 million patients are transferred between hospitals yearly, with disproportionately high cost and mortality. Despite the risk associated with inter-hospital transition of care, there is no established best practice in coordinating and triaging transfers. This gap in knowledge is partly driven by a dearth of studies which integrate clinical data before and after [...]

Background: Coronavirus disease of 2019 (COVID-19) is a novel widespread disease that has a range of manifestation from asymptomatic to fatal. In the United States, there have been approximately 396,000 hospitalizations as of this writing, of which an estimated 25% will require the intensive care unit (ICU)1,2. With the ongoing spread and repeated waves of [...]

Background:  Transitions of care, whether between or within institutions, are an important source of errors, inefficiency, and unnecessary costs.  Inter-hospital transfers are complicated by incongruent information systems, indirect and asynchronous communication, and geographical distance all in settings of high patient complexity and acuity.  We developed a large database of patients transferred between hospitals to identify [...]

Background: Capacity constraints are a common problem at many academic institutions.  At Duke University Hospital (DUH) , capacity constraints continue to result in critical bed shortages.  Our affiliated hospital, Duke Regional Hospital (DRH) which is less than 5 miles away, has the capacity and capability to provide care to these general medicine patients. Shifting general [...]

Background: Prolonged intensive care unit (ICU) length of stay (LOS) has been shown to delay patients’ recovery, increase their exposure to the risk of infections, upsurge healthcare costs, and reduce care availability to other critically ill patients. ICU LOS is directly influenced by both medical and institutional factors. The aim of the project is to [...]

Background: It is common for Inter-Intensive Care Unit (ICU) transfers between hospitals to take place to provide a patient with a higher level of care to improve clinical outcomes. The decision to transfer ICU patients is not standardized and leads to a wide variability in transfer practice patterns. This may lead to higher cost, burden [...]

Background:  As electronic health records (EHR) become ubiquitous, the impact on patient outcomes remains largely unknown.  One major communication barrier during patient transfers is the lack of interoperability between EHR systems.  Inter-hospital transfers involve transitioning high acuity patients between hospital systems that may not be able to directly communicate with one another, creating the ideal [...]

Case Presentation: Our patient is a 74-year-old male with a history of thrombocytopenia thought secondary to ITP, hypothyroidism, and prior spontaneous coronary artery dissection requiring cardiac bypass who was transferred from an outside hospital for acute kidney injury and abdominal distention. A few weeks prior to admission, the patient experienced congestion, cough and low-grade fever [...]

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 [...]