Towards the development of a national patient transfer document between residential and acute care—A pilot study

Abstract

Background A lack of standardisation of documentation accompanying older people when transferring from residential to acute care is common and this may result in gaps in information and in care for older people. In Ireland, this lack of standardisation prompted the development of an evidence based national transfer document. Objectives To pilot a new national transfer document for use when transferring older people from residential to acute care and obtain the perceptions of its use from staff in residential and acute care settings. Methods This was a pre‐ and post‐study design using purposive sampling following the STROBE guidelines. The pilot was conducted in 26 sites providing residential care and three university hospitals providing acute care. Pre‐pilot questionnaires focused on current documentation and were distributed to staff in residential care (n = 875). A pilot of the new paper‐based transfer document was then conducted over three months and post‐pilot questionnaires distributed to staff from both residential and acute care settings (n = 1085). The findings of the pilot study were discussed with multidisciplinary expert advisory and stakeholder groups who recommended some revisions. This consensus informed the development of the final design of the new revised transfer document. Results Pre‐pilot: 23% response rate; 83% (n = 168) participants agreed/strongly agreed that existing documentation was straightforward to complete but could be more person‐centred. Post‐pilot: 11% response rate; 75% (n = 93) of participants agreed/strongly agreed that the new transfer document promoted person‐centred care but recommended revisions to the new document regarding layout and time to complete. Conclusions This study highlighted some of the challenges of providing safe, effective and relevant transfer information that is feasible and usable in everyday practice. Implications for practice Standardisation and being person‐centred are important determining factors in the provision of relevant up to date information on the resident being transferred.

Barriers to an Effective and Efficient Intra- and Inter-Establishment Transfer of Elderly Patients in Healthcare: A Scoping Review

“…Most of the barriers cited were healthcare provider level barriers [14][15][16][17][18][19][20][21][22][23][24][25]. The remaining barriers were split between individual level [14][15][16]22,[26][27][28][29] and organizational level barriers [14][15][16][17]22,23,25,30]. An overview of the 18 articles follows.…”

“…Inadequate, unclear, and disorganized transfer data [14,20,[23][24][25]30] and invalid medication lists [24] contributed to confusion among facilities regarding the handling of patients' medication information [19] and discharge papers [21]. In studies conducted in the United States, it was found that some healthcare practitioners did not educate patients about selfmanagement and resources available to help them in their post-discharge life [14], thus failing to appropriately prepare patients for their care transition [20].…”

“…Organizational level barriers relate to coordination errors during care transitions between discharging and receiving facilities [14]. Organizational level barriers were cited in 8 of the 18 articles [14][15][16][17]22,23,25,30]. Barriers in in organizational discharge planning were cited in five articles [14,15,17,25,30].…”

“…Organizational level barriers were cited in 8 of the 18 articles [14][15][16][17]22,23,25,30]. Barriers in in organizational discharge planning were cited in five articles [14,15,17,25,30]. Ideally, it is the responsibility of the discharging facility to place the patient in the most medically appropriate setting and to organize the discharge process with the receiving facility [14].…”

“…However, many errors occur in discharge arrangements that reflect poor planning-one such error highlighted by Ouslander et al (2020) is the inappropriate discharge of the patient to a lower level of care when the discharge should have been to a facility with a higher level of care. Another error that reflects poor organizational discharge planning is the lack of a comprehensive discharge document that contains transfer documentation details, design framework, and the essentials of care [30].…”