Effect of a Handover Tool on Efficiency of Care and Mortality for Interhospital Transfers

Theobald, Cecelia; Choma, Neesha N.; Ehrenfeld, Jesse M.; Russ, Stephan; Kripalani, Sunil

doi:10.1002/jhm.2669

Cited by 18 publications

(15 citation statements)

References 20 publications

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“…40 Our data suggest that the complex system of interfacility transfer that supports rural hospitals helps to ensure similar outcomes for people experiencing life-threatening illness at rural EDs. Efforts to improve interfacility transfer for select life-threatening conditions 41,42 through regionalization 37,[43][44][45] and standardization of processes 46 have reduced mortality and improved quality measure performance. Although our data may suggest that interfacility transfer is optimized, it is often described as difficult, deeply fragmented, 20 and requiring complex coordination efforts by the rural clinician.…”

Section: Discussionmentioning

confidence: 99%

Association of Rural and Critical Access Hospital Status With Patient Outcomes After Emergency Department Visits Among Medicare Beneficiaries

et al. 2021

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IMPORTANCERural US residents disproportionately rely on emergency departments (ED), yet little is known about patient outcomes after ED visits to rural hospitals or critical access hospitals (CAHs).OBJECTIVE To compare 30-day outcomes after rural vs urban ED visits and in CAHs, a subset of rural hospitals. DESIGN, SETTING, AND PARTICIPANTSThis propensity-matched, retrospective cohort study used a 20% sample of national Medicare fee-for-service beneficiaries from January 1, 2011, to October 31, 2015. Rural and urban ED visits were matched on demographics, patient prior use of EDs, comorbidities, and diagnoses. Thirty-day outcomes overall and stratified by 25 common ED diagnoses were evaluated, with similar analysis of CAHs vs non-CAHs. Data were analyzed from February 15, 2020, to May 17, 2021. MAIN OUTCOMES AND MEASURESThe primary outcome was 30-day all-cause mortality.Secondary outcomes were ED revisits with and without hospitalization. RESULTSThe matched cohort included 473 152 rural and urban Medicare beneficiaries with a mean (SD) age of 75.1 (7.9) years (59.1% and 59.3% women, respectively; 86.9% and 87.1% White, respectively). Medicare beneficiaries at rural vs urban EDs experienced similar all-cause 30-day mortality (3.9% vs 4.1%; effect size, 0.01), ED revisits (18.1% vs 17.8%; effect size, 0.00), and ED revisits with hospitalization (6.0% vs 8.1%; effect size, 0.00). Rural ED visits were associated with more transfer (6.2% vs 2.0%; effect size, 0.22) and fewer hospitalizations (24.7% vs 39.2; effect size, 0.31). Stratified by diagnosis, patients in rural EDs with life-threatening illnesses experienced more transfer with 30-day mortality similar to that of patients in urban EDs. In contrast, mortality differed for patients in rural EDs with symptom-based diagnoses, including chest pain (odds ratio [OR], 1.54 [95% CI, 1.25-1.89]), nausea and vomiting (OR, 1.68 [95% CI,, and abdominal pain (OR, 1.73 [95% CI,). All findings were similar for CAHs. CONCLUSIONS AND RELEVANCEThe findings of this cohort study of rural ED care suggest that patient mortality for potentially life-threatening conditions is comparable to that in urban settings.Further research is needed to understand the sources of greater rural ED mortality for symptombased conditions. These findings underscore the importance of ensuring access to treatment of lifethreatening conditions at local EDs in rural communities, which are increasingly endangered by hospital closures.

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Section: Discussionmentioning

confidence: 99%

Association of Rural and Critical Access Hospital Status With Patient Outcomes After Emergency Department Visits Among Medicare Beneficiaries

et al. 2021

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“…Our results signify the fact that ED timeliness of care for IHT patients should not be considered as just an ED operational issue and relies on the established IHT system among hospitals, including the communication prior to transfer and handoff/handover strategies during transfer [ 3 , 4 , 39 ]. Sufficient interhospital communication, complete medical data transfer, timely ED treatments, and active bed management may contribute to expediting ED care for IHT patients.…”

Section: Discussionmentioning

confidence: 81%

Impact of interhospital transfer on emergency department timeliness of care and in-hospital outcomes of adult non-trauma patients

Chen¹,

Wen²

2023

Heliyon

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“…High quality communication and information exchange during care changeovers is imperative for preventing adverse events resulting from discontinuity of care, especially when there is evidence that a structured handover reduces mortality after interhospital transfer. 92,93 However, further studies are needed to see if inadequacy of communication has less impact on the outcome of repatriation cases compared to clinical and capacity transfers since repatriation is believed to take place when the patient is more stable and to occur with some advance notice and hence should constitute a more structured and informative discharge note, as well as less-rushed oral handover. Additionally, patients undergoing an ICU-to-ICU interhospital transfer as well as discharge to wards at night are a particularly sick subset of hospitalised patients with sometimes days of crucial information that must be compressed and redistributed.…”

Section: Findings Interpretation and Further Discussionmentioning

confidence: 99%

Premature Discharge from Intensive Care with Special Reference to Night-Time Discharge and Capacity Transfers

Parenmark

2023

Linköping University Medical Dissertations

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ObjectivesIntensive care is an expensive and limited resource, and when a demand supply mismatch between available beds and influx of patients occurs, one temporary measure is to discharge a patient to make room for the new admission. Sometimes the patient is discharged sooner from its original ICU than ideal; i.e., a so-called 'premature discharge'. This could be either to a different ward within the same hospital if the patient is deemed well enough to cope with a lower level of care, or to another intensive care unit if critical care is still to be provided. Data from the Swedish intensive care register (SIR) showed that there was a high incidence and increased mortality of patients discharged at night. There were also differences in mortalities between patients that were transferred from one ICU to another. I have analysed the mortality associated with different types of ICU-to-ICU transfers and control groups and examined a national quality improvement project regarding discharges at night to see if mortality, incidence, or discharge culture could change. MethodsAll three studies are conducted with data from the Swedish intensive care register and vital status was ascertained by linking SIR to the Swedish population register. Study I consisted of two parts: mortality, and incidence of night-time discharge. The quality improvement project in Study I was analysed in a before and after approach with local improvement projects at different ICUs. In Studies II and III, transfers were grouped by the attending intensivist according to SIR guidelines into one of three defined categories: capacity transfer, clinical transfer, or repatriation. The groups were compared to each other in Study II, and capacity transfers were matched to a control group that remained in the ICU in Study III. Multilevel logistic regression was used, and all studies contained some statistics using individual ICUs as a random factor. Life sustaining treatment limitations were included in Studies II and III. WD Withholding Care Regarding limitations of care (see LSTL) WH Whitdrawing Care Regarding limitations of care (see LSTL)

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Effect of a Handover Tool on Efficiency of Care and Mortality for Interhospital Transfers

Abstract: BACKGROUND: Interhospital transfer is frequent, and transferred patients experience delays in the provision of care and higher mortality rates when compared to patients directly admitted. The interhospital handover is a key opportunity to improve care but has not been evaluated.

Cited by 18 publications

References 20 publications

Association of Rural and Critical Access Hospital Status With Patient Outcomes After Emergency Department Visits Among Medicare Beneficiaries

Association of Rural and Critical Access Hospital Status With Patient Outcomes After Emergency Department Visits Among Medicare Beneficiaries

Impact of interhospital transfer on emergency department timeliness of care and in-hospital outcomes of adult non-trauma patients

Premature Discharge from Intensive Care with Special Reference to Night-Time Discharge and Capacity Transfers

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