The Seamless Transfer-of-Care Protocol: a randomized controlled trial assessing the efficacy of an electronic transfer-of-care communication tool

Abstract

BackgroundThe transition between acute care and community care represents a vulnerable period in health care delivery. The vulnerability of this period has been attributed to changes to patients’ medication regimens during hospitalization, failure to reconcile discrepancies between admission and discharge and the burdening of patients/families to take over care responsibilities at discharge and to relay important information to the primary care physician. Electronic communication platforms can provide an immediate link between acute care and community care physicians (and other community providers), designed to ensure consistent information transfer. This study examines whether a transfer-of-care (TOC) communication tool is efficacious and cost-effective for reducing hospital readmission, adverse events and adverse drug events as well as reducing death.MethodsA randomized controlled trial conducted on the Medical Teaching Unit of a Canadian tertiary care centre will evaluate the efficacy and cost-effectiveness of a TOC communication tool. Medical in-patients admitted to the unit will be considered for this study. Data will be collected upon admission, and a total of 1400 patients will be randomized. The control group’s acute care stay will be summarized using a traditional dictated summary, while the intervention group will have a summary generated using the TOC communication tool. The primary outcome will be a composite, at 3 months, of death or readmission to any Alberta acute-care hospital. Secondary outcomes will be the occurrence of post-discharge adverse events and adverse drug events at 1 month post discharge. Patients with adverse outcomes will have their cases reviewed by two Royal College certified internists or College-certified family physicians, blinded to patients’ group assignments, to determine the type, severity, preventability and ameliorability of all detected adverse outcomes. An accompanying economic evaluation will assess the cost per life saved, cost per readmission avoided and cost per QALY gained with the TOC communication tool compared to traditional dictation summaries.DiscussionThis paper outlines the study protocol for a randomized controlled trial evaluating an electronic transfer-of-care communication tool, with sufficient statistical power to assess the impact of the tool on the significant outcomes of post-discharge death or readmission. The study findings will inform health systems around the world on the potential benefits of such tools, and the value for money associated with their widespread implementation.Trial registrationClinicalTrials.gov NCT01402609.

Barriers to discharge in an acute care medical teaching unit: a qualitative analysis of health providers’ perceptions

“…Currently, a randomized clinical trial is underway assessing the efficacy of the transfer of care summary in regards to adverse events, readmission, and mortality, with secondary endpoints of timeliness and patient and physician satisfaction. 34 It is thought that an electronic transfer of care summary can be at least a partial solution to poor health care provider-patient interaction. 34 When leaving the hospital, patients receive a full copy of their transfer of care summary which contains information about their follow-up appointments.…”

“… 34 It is thought that an electronic transfer of care summary can be at least a partial solution to poor health care provider-patient interaction. 34 When leaving the hospital, patients receive a full copy of their transfer of care summary which contains information about their follow-up appointments. The summary clarifies the status of the appointments, indicating if the appointment has already been scheduled, in which case the date and time of the appointment is included (eg, for follow-up magnetic resonance imaging), whether the clinic will be contacting the patient to schedule an appointment (eg, internal medicine clinic), or whether the patient is required to arrange the appoint on their own (eg, with family doctor).…”

Discontinued Medications: Are They Really Discontinued?

“…In one study, the use of secure messaging for medication reconciliation, particularly during transitions of care, was also evaluated 13 . The Seamless Transfer of Care Protocol, an electronic transfer‐of‐care communication tool, is currently being studied to determine whether it can help decrease readmissions, adverse events, and deaths 14 …”

Digitalisierung und Patientensicherheit

“…Der Vorteil bzw. Nutzen, den dies gegenüber reinen papierbasierten Informationsübermittlungen entfaltet, wird in den hier eingruppierten Publikationen untersucht und grundsätzlich bestätigt (Okoniewska et al 2012). Dabei wird jedoch auch offensichtlich, dass ein elektronisch unterstütztes Entlassmanagement einschließlich der Ausstellung eines digitalen Medikationsplans oder Rezepts nur so gut sein kann wie die Dokumentation der Daten in den vorausgegangenen Prozessschritten.…”