Hospital transfers involve transferring a hospitalized or non-hospitalized patient, in the case of outpatient settings, between acute care hospital systems [5]. Communication is crucial in hospital care transitions and can significantly affect patient outcomes [1]. Hospital transfers pose interesting challenges due to the level of communication needed between various providers, settings, and healthcare systems. Extensive research has been done on physician and patient perspectives on hospital transfers. Some studies have shown that transferred patients experience longer length of hospital stays, longer ICU stays, greater mortality, and overall worse outcomes [1,2]. Patients who are transferred may be at higher risk of poor care due to miscommunications and lack of continuity. Further, this can also result in physicians feeling unprepared to care for patients, especially those who are severely ill, at the time of the transfer.  

There are two main barriers to transferring patients: inter-hospital communication, or the transfer of clinical information between hospital systems, and intra-hospital communication, or key patient information that is shared among the relevant healthcare providers. There are many factors and key players involved in inter- and intra-hospital communication and thus there is plenty of room for error.  

The first key step to a successful transfer is advance notification. This allows time for handoff of important patient data and for the admitting clinicians to prepare for patient arrival regardless of the severity of illness [1]. This advance notification is a page or message with the patient’s name and medical record number that is sent to the admitting clinician from a nurse who has already assigned the transferring patient to a bed. Prior research has found that these advance notification pages are inconsistent and thus begin the domino effect of miscommunication during a transfer [4]. One study found that in a stakeholder meeting with key providers and staff, the big contributing factors to failure of advance notification included the nurse being unaware of a bed assignment for a transferred patient, and handoffs between healthcare providers occurring during the time of the transfer assignment, resulting in a delay in the sharing of important patient information [1]. This area is an important target of interventions to improve transmission of patient information and ensure proper communication among all involved staff.  Interventions and solutions include checklists, streamlining roles to ensure every task is covered, and creating an automatic paging system within the electronic health record.  

In terms of patient perspectives, there are pros and cons to hospital transfers. Some benefits cited by patients include improved access to specialized care, availability of second opinions from other providers, and more consideration of patient preferences [6]. On the other hand, cons to hospital transfers include risk of discontinuity of care – patients can more easily be lost to follow-up. Further, transfers can introduce additional delays to care for diagnostic tests, decision making for treatment plans, and even patients seeing the admitting attending doctor. This can lead to not only poor health outcomes but dissatisfaction with the overall process. Thus, interventions to improve the process of hospital transfers must aim to target not only physician perspectives but patient perspectives and comfort as well.  

References 

1. Mueller, Stephanie, et al. “An Initiative to Improve Advanced Notification of Inter-Hospital Transfers.” Healthcare, vol. 8, no. 2, June 2020, p. 100423, 10.1016/j.hjdsi.2020.100423.  

2. Sokol-Hessner, Lauge, et al. “Interhospital Transfer Patients Discharged by Academic Hospitalists and General Internists: Characteristics and Outcomes.” Journal of Hospital Medicine, vol. 11, no. 4, 20 Nov. 2015, pp. 245–250, 10.1002/jhm.2515.  

3. Starmer, Amy J., et al. “Changes in Medical Errors after Implementation of a Handoff Program.” New England Journal of Medicine, vol. 371, no. 19, 6 Nov. 2014, pp. 1803–1812, 10.1056/nejmsa1405556. 

4. Mueller, Stephanie K., et al. “Patient and Physician Experience with Interhospital Transfer.” Journal of Patient Safety, June 2018, p. 1, 10.1097/pts.0000000000000501.  

5. Mueller, Stephanie K, et al. “Rates, Predictors and Variability of Interhospital Transfers: A National Evaluation.” Journal of Hospital Medicine, vol. 12, no. 6, 1 June 2017, pp. 435–442, 10.12788/jhm.2747.  

6. Gupta, Kiran, and Stephanie K. Mueller. “Interhospital Transfers: The Need for Standards.” Journal of Hospital Medicine, vol. 10, no. 6, 28 Jan. 2015, pp. 415–417, 10.1002/jhm.2320.