Possible Solutions to Poor Interhospital Transfers
By Melinda Young
Interhospital transfers can be frustrating to nurses and lead to worse outcomes for patients, research shows.1-3 But hospitals can take steps to improve the process and reduce risks for patients.
The first step is to eliminate unnecessary transfers, says Amy Yu, MD, an assistant professor in the division of hospital medicine at the University of Colorado.
Transfers Not Always Needed
Sometimes, patients are better off if they are not transferred. They may not need the procedure, or their health outcomes could be better if they remain at the original hospital. Administrators and providers should develop better policies and procedures for assessing whether a transfer is the best decision.
“Limited studies show interhospital transfer patients, even when adjusted for clinical acuity and severity, when compared to emergency room patients for the same diagnosis, have longer lengths of stay, [higher] costs, and higher mortality,” Yu says. “It’s because of poor care coordination.”2,3
Hospital staff do not communicate as quickly and accurately with the receiving hospital. This leads to delays of treatment, such as antibiotic administration, procedures, and pain relief.
“There is something in care coordination we really need to be looking at to make sure we provide patients better care,” Yu says. “Something is causing this to happen.”
As a resident, Yu was called to admit a patient who had been transferred from another hospital and had been waiting on the floor for four to six hours. “The patient was in pain and was hungry, and the patient’s chart didn’t have any images or packet of information,” she recalls. “I introduced myself to the patient, and I remember the patient’s husband jumping from the back, saying, ‘Where have you been? She is crying in pain, and our doctor — from a small rural hospital — said this is the best hospital.’”
Yu had no idea what was going on with the patient because there was no information from the transferring hospital. “I felt awful that this physician had given us so much trust, and this patient and family also had this trust, and we broke the trust and had to start from square one,” she explains. “This was a frustrating situation for everyone. It spurred my interest in interhospital transfers.”
Another step hospitals can take is to assign a care coordinator or case manager to help with interhospital transfers. “In our study, nurses brought up case management coordination issues,” Yu says. “A lot of patients come from rural areas, and this creates downstream problems because case managers and care coordinators have difficulty placing patients to where they’re closer to family or can find appropriate services.”
If case managers were involved with the interhospital transfer (particularly at sending hospitals) from the start, it could help improve the transfer experience for patients, since case managers have a lot of insight into what patients need. “Right now, there is a lack of ownership about who owns the information and how to get that information to the next party,” Yu says. “This may be an opportunity for case managers to own the information exchange piece, making sure that the discharge summary, medication list by the last administration, and antibiotic information about the patient’s care are in the packet that goes with the patient.”
Sometimes, receiving hospitals admit patients without a packet, or the packet was lost during the transfer. Involving a case manager to ensure the packet is with the patient would greatly help receiving hospitals and their nursing staff.
“Care managers are so great, and this is a piece where they really could contribute,” Yu says. Another solution would be to use a standardized checklist of information with every handoff, she adds.
REFERENCES
- Yu A, Jordan SR, Gilmartin H, et al. “Our hands are tied until your doctor gets here:” Nursing perspectives on inter-hospital transfers. J Gen Intern Med 2022;37:1729-1736.
- Mueller SK, Fiskio J, Schnipper J. Interhospital transfer: Transfer processes and patient outcomes. J Hosp Med 2019;14:486-491.
- Hernandez-Boussard T, Davies S, McDonald K, Wang NE. Interhospital facility transfers in the United States: A nationwide outcomes study. J Patient Saf 2017;13:187-191.
Interhospital transfers can be frustrating to nurses and lead to worse outcomes for patients, research shows. But hospitals can take steps to improve the process and reduce risks for patients. The first step is to eliminate unnecessary transfers.
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