Dr. Stephanie Mueller, MD, MPH*1,2;Evan Michael Shannon, MD, MPH2;Jeffrey L Schnipper, MD, MPH1,2 and Patricia C Dykes, RN, PhD1,2, (1)Harvard Medical School, Boston, MA, (2)Brigham and Women's Hospital, Boston, MA

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 258

Categories: Research Abstracts, Transitions of Care

Keywords: ,

Background: Inter-hospital transfer (IHT, the transfer of patients between acute care hospitals) exposes patients to risks of discontinuity of care and remains a largely unstudied process of care. In this study, we aimed to investigate patient experiences with IHT.Methods: Interview guides were developed using themes extracted from prior research along with expert opinion and stakeholder input. We conducted semi-structured interviews on a purposeful sample of patients transferred within the previous 48 hours to the General Medicine or Cardiology services at Brigham and Women’s Hospital, or Oncology service at Dana Farber Cancer Institute (Boston, MA) from any other acute care facility. Content analysis was used to interpret descriptive data obtained from transcribed interviews. Using an a priorianalytic framework based on the interview guides, two independent reviewers (SKM, ES) coded data into discrete categories, meeting regularly for analytic discussions to review themes and modify interpretations in an iterative fashion.

Results: Interviews were conducted with 10 recently transferred patients (2 general medicine, 6 cardiology, 2 oncology). Analysis of patient experience with IHT yielded three primary themes: (1) “Decision to transfer,” including reason for transfer and expectations of care; (2) “Communication regarding transfer,” including related to timing of transfer and information exchange between transferring and receiving treatment teams; and (3) “The transfer process,” including the physical transfer process and impressions on arrival. Patients often described a joint decision to transfer between themselves and the referring care team, most often to receive more specialized care, and most often expressed happiness and/or relief about the transfer. Most patients expressed dissatisfaction with issues surrounding the timing of transfer, including time of day, delay after decision, and lack of notice once transfer was happening, with less focus on the information exchange between providers. Patients often focused on the physical transfer process (ambulance ride) and first impressions of their room and care team on arrival in discussions of their overall impressions of IHT (Table).

Conclusions: Appreciating patients’ experience with IHT is an essential step towards a deeper understanding of the impact of IHT on the primary stakeholders involved. Notably, patients tended to focus on elements of IHT that more directly impacted them, including issues related to timing of transfer, and the physical transfer process, with less focus on issues such as information exchange between providers of which they might be less directly aware. These identified themes may provide important patient-centered targets in improving this process of care.

To cite this abstract:

Mueller, S; Shannon, EM; Schnipper, JL; Dykes, PC . PATIENT EXPERIENCE WITH INTER-HOSPITAL TRANSFER: A QUALITATIVE STUDY. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 258. Journal of Hospital Medicine. 2017; 12 (suppl 2). Accessed May 20, 2019.

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