Clinicians’ views on improving inter-organizational care transitions

Abstract

BackgroundPatients with complex health conditions frequently require care from multiple providers and are particularly vulnerable to poorly executed transitions from one healthcare setting to another. Poorly executed care transitions can result in negative patient outcomes (e.g. medication errors, delays in treatment) and increased healthcare spending due to re-hospitalization or emergency room visits by patients. Little is known about care transitions from acute care to complex continuing care and rehabilitation settings. Thus, a qualitative study was undertaken to explore clinicians’ perceptions of strategies aimed at improving patient care transitions from acute care hospitals to complex continuing care and rehabilitation healthcare organizations.MethodsA qualitative study using semi-structured interviews was conducted with clinicians employed at two selected healthcare facilities: an acute care hospital and a complex continuing care/rehabilitation organization, respectively. Analysis of the transcripts involved the creation of a coding schema using the content analyses outlined by Ryan and Bernard. In total, 31 interviews were conducted with clinicians at the participating study sites.ResultsThree themes emerged from the data to delineate what study participants described as strategies to ensure quality inter-organizational transitions of patients transferred from acute care to the complex continuing care and rehabilitation hospital. These themes are: 1) communicating more effectively; 2) being vigilant around the patients’ readiness for transfer and care needs; and 3) documenting more accurately and completely in the patient transfer record.ConclusionOur study provides insights from the perspectives of multiple clinicians that have important implications for health care leaders and clinicians in their efforts to enhance inter-organizational care transitions. Of particular importance is the need to have a collective and collaborative approach amongst clinicians during the inter-organizational care transition process. Study findings also suggest that the written patient transfer record needs to be augmented with a verbal report whereby the receiving clinician has an opportunity to discuss with a clinician from the acute care hospital the patient’s status on discharge and plan of care. Integral to future research efforts is designing and testing out interventions to optimize inter-organizational care transitions and feedback loops for complex medical patients.

Barriers to Communication and Information Exchange in Patient Transfer and Its Consequences

“…The findings of this study are consistent with some studies that expressed barriers such as transferring patients without relevant documents, uselessness and non-applicability of the documents, and also not completing information or incomplete processing of information (King et al, 2013;Terrell & Miller, 2006). Providing the patient's accurate and complete medical record is an effective strategy to ensure the quality of patient transfer (Jeffs, Lyons, Merkley, & Bell, 2013). It seems that lack of knowledge on the importance of information, lack of awareness on the main components of the patient's medical history and various expectations of the specialists can be the reasons for providing incomplete history and non-delivery of related documents.…”

Continuity of Care during Care Transition: Nurses’ Experiences and Challenges

“…This was discussed as an important supplementary to the electronic documentation. The professional benefits of verbal dialogue are also found in previous research [33]. We argue that care transition does not just involve the passing of the patient from one point to another.…”

Care Transitions Between Hospitals and Skilled Nursing Facilities: Perspectives of Sending and Receiving Providers

“…Numerous studies of care transitions suggest that including multiple perspectives not only strengthens data analysis but also fosters collaboration across facilities and systems, ultimately enriching quality improvement efforts (28–31). Researchers have previously used this multidisciplinary approach to examine care transitions between Canadian hospitals and post-acute care settings, identifying opportunities to improve communication and enhance the patient’s transfer experience (19, 31).…”