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:  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:  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 [...]

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 [...]

Background: At academic institutions and other referral centers the process of accepting transfers from other hospitals has been a challenging and potentially laborious process to coordinate smoothly. It was also one that was not previously reimbursable. However, beginning in 2017 Medicare and other insurance companies began reimbursing Non-Face-to-Face Prolonged services procedural codes. These new codes [...]

Background: Interhospital transfer (IHT) processes vary across institutions. The fragmented and complex nature of IHTs pose patient safety risks. The implementation of a standardized IHT process with a templated note for hospital medicine patients at our institution demonstrated promising patient safety outcomes and a significant increase in physician satisfaction. A second, iterative intervention expanded this [...]

Background: Interhospital transfers (IHT) for additional care are a necessary, if high-risk, part of the healthcare system. Return transfers, in which the patient is returned to the referring hospital once higher-level care is no longer needed, are also a part of the healthcare system but are even more varied and less systematized and studied within [...]