Interhospital transfer (IHT) is a highrisk transition of care that often involves patients with complex and worsening medical problems. Ineffective handoffs between providers may contribute to errors and adverse events during IHTs. Even within the receiving institution, the accepting provider may pass admission responsibilities to a colleague, introducing another handoff. Hospitalists need tools to enhance communication during IHTs. Pretransfer documentation of clinical data and radiographic images in the electronic medical record (EMR) as opposed to an unofficial signout system may facilitate asynchronous information sharing among accepting providers.
To develop tools and policies that improve withinhospital communication about IHTs.
Our hospital is a 450 bed academic referral center with a transfer center. Multiple hospitalists share the role of triaging and accepting IHTs to our medicine services during each 24hour period. Either resident teams or hospitalists may be designated to admit the patients on arrival. To better coordinate care, we began using an EMR template for pretransfer documentation in July 2011. For patients lacking a medical record number, our transfer center creates a pretransfer registration encounter to permit documentation. Hospitalists then fill out the template during phone calls with the referring provider and save the information in the official EMR, where it is accessible to care team members. The template prompts clinicians to evaluate the reason for transfer and events to date, specific information about the patient’s clinical stability, and unique resource or nursing needs. Our medical center hosts a secure network that permits upload of radiographic images from 110 hospitals in our region, so all relevant imaging is associated with the pretransfer encounter. The transfer note is then electronically routed to the EMR inbox of the admitting team and consulting subspecialists. Pending transfers are added to an electronic patient list shared by accepting providers. Anecdotally, this system has prevented unplanned ICU transfers, reduced repeat imaging, and improved communication amongst all providers. Whether patients arrive with or without medical records, these notes provide detailed “doctodoc” information. If an IHT is delayed, these notes are easily reviewed and addended by subsequent providers. The notes have also allowed charge nurses to optimize nursing assignments prior to transfer.
This innovation has standardized patient triage, facilitated better and more efficient communication among accepting and admitting providers, consulting subspecialists and nursing staff, and anecdotally improved care. Future work will evaluate the cost and quality effects of these communication improvements.
To cite this abstract:White A, SokolHessner L. Experience Using an Electronic Medical Record (Emr) to Improve Communication Around the Time of Interhospital Transfer. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97682. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/experience-using-an-electronic-medical-record-emr-to-improve-communication-around-the-time-of-interhospital-transfer/. Accessed May 23, 2019.