Assessing and Improving Handoff Communications for Interhospital Transfers at an Academic Medical Center

1Hospital of the University of Pennsylvania, Philadelphia, PA
2Thomas Jefferson University, Philadelphia, PA
3Hospital of the University of Pennsylvania, Philadelphia, PA
4Hospital of the University of Pennsylvania, Philadelphia, PA

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 159

Background:

Poor handoff communication poses a threat to patient safely. The medical literature to dale has focused on handoffs within a single facility or at hospital discharge. There are no assessments of the quality of handoffs for patients transferred from outside hospitals (OSHs). which is a common occurrence at academic medical centers.

Purpose:

To assess resident satisfaction with the quality of handoff communications for patients transferred from OSHs to an academic medical center and to improve these handoffs through the development and implementation of an internet‐based communication tool.

Description:

Our hospital is a 600‐bed university hospital that accepts approximately 3500 patients from OSHs annually. Attending physicians accept patients and receive a handoff from physicians at the sending hospital. Historically, there was little or no communication between this attending and the resident who would care for the transferred patient on arrival. To assess baseline conditions, we surveyed internal medicine residents regarding their satisfaction with the handoff process and their perceptions of the impact of handoff communication on patient care. Based on These results, we designed and implemented an online handoff communication tool for attendings to complete when accepting a patient for transfer. The tool, which includes prompts for key handoff items, is linked to the patient's electronic medical record and available for all providers to view many hours before the patient's arrival. As a potential outcome marker of poor handoff communication, we also identified the number of patients transferred over 1 year who were upgraded to an ICU shortly after their arrival from the OSH.

Conclusions:

Eighty‐three residents (81% response rate) completed the survey and documented large opportunities for improvement. Ninety‐three percent of residents were dissatisfied with the quality of OSH transfer handoffs, 92% reported never or rarely receiving a complete handoff about these patients, anc 96% felt that patient care was compromised at least some of the time because of this poor communication. Among 737 patients transferred from OSHs to our medical wards, 25% were upgraded to an ICU during their hospitalization, and many upgrades occurred soon after arrival: 40% were upgraded wilhin 48 hours and 11% within 12 hours. Although there are many clinical factors that can lead to ICU transfer, inadequate handoff communication may contribute. Trie high rale of ICU transfers confirms the acuity of these patients and lends further importance to improving the quality of handoffs for this population. We are auditing the use of the online handoff tool as a process metric to facilitate feedback for nonusers in different divisions. We plan to repeal our resident survey after the tool is widely adopted and perform chart reviews to better assess the relationship between handoff communication and early ICU transfer.

Author Disclosure:

K. Christensen, none; S, Krekun, none; T. Bell, none; J. Myers, none.

To cite this abstract:

Christensen K, Krekun S, Bell T, Myers J. Assessing and Improving Handoff Communications for Interhospital Transfers at an Academic Medical Center. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 159. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/assessing-and-improving-handoff-communications-for-interhospital-transfers-at-an-academic-medical-center/. Accessed May 23, 2019.

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