Deficits in Referral Notes During Inter-hospital Transfers of Critically Ill Patients: An Observational Study from a Developing Nation

Abstract

Aim: Currently there are no guidelines regarding the content of the clinical notes needed for transfer of patients from one centre to another. This problem is manifold in developing countries where intensive care is a developing specialty. This study was conducted to analyse the patient's clinical information provided by the referral summary at the time of ICU admission.Settings: Twelve bedded intensive care unit (ICU) of a 900 bedded tertiary care referral centre.Observations: Over a period of 1 year, we had 310 intensive care admissions. One hundred and twenty-four patients out of these were out of hospital admissions. Ninty-six patients out of 124 patients had a prior hospitalisation of more than 24 hours. Patient information regarding the clinical details, source of referral, severity of illness, course in the previous hospital and management were analysed at time of admission.There were 62 (64%) male and 34 (36%) female patients. Mean admission APACHE-II (Acute physiological and chronic health evaluation) of referred patients was 15.89 ± 2.89 and mean SOFA (Sequential organ failure assessment) was 8.2083 ± 1.86.Authors found that majority of referral notes did not provide information regarding the presenting complaints, progression of signs and symptoms, progression of the organ failures, neurological assessment, airway and intubation details, ventilator settings on the blood gases, trends of vital parameters, nutrition, DVT prophylaxis and clinical status at time of discharge. Conclusion:Guidelines should be developed for the content of referral summaries to maintain continuity of care and avoid delay in institution of life saving therapies.

Patient and healthcare provider knowledge, attitudes and barriers to handover and healthcare communication during chronic disease inpatient care in India: a qualitative exploratory study

“…For example, reports from both HCPs and patients revealed that that documented information was often provided in the form of minimal, handwritten notes on papers provided for other purposes (eg, prescription cards). These findings reflect results from other LMIC studies that have evidenced the exchange of poor-quality referral documents 14 37–39. However, the current study also evidenced patient reports of not being provided with any documented information during referrals.…”

“…A recent (2019) study from South Africa has found inadequate discharge planning to be a significant contributor to avoidable causes of hospital readmission 13. Across India, a handful of predominantly single-site studies have evaluated and described deficiencies in information exchange during referrals, hospital shift change and discharge 14–19. The current study forms part of a series completed for a project investigating handover and continuity of care for patients with chronic NCDs in the states of Kerala and Himachal Pradesh in India.…”