Optimizing the Safety of Inter-Hospital Transfer

Inpatient Facililty Diagnoses Clinical Trial

Official title:

Optimizing the Safety of Inter-Hospital Transfer

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT05876429
• Other study ID #: 2020P001945
• Status: Active, not recruiting
• Phase: N/A
• Start date: August 17, 2020
• Est. completion date: June 30, 2023

Study information

• Verified date: May 2023
• Source: Brigham and Women's Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This proposal aims to design, implement and rigorously evaluate a standardized accept note in a population of patients that have high frequency of IHT, including patients transferred to the general medical (GMS), cardiology and oncology services at a large tertiary care hospital. This study will improve scientific knowledge by quantifying the patient safety impact of an intervention to improve communication of essential clinical information during IHT. If shown effective, the results of this study can be used to improve clinical practice by establishing evidence-based communication guidelines for broad dissemination. We will also establish technical feasibility by successfully implementing this tool within our EHR (Epic, Verona, WI), allowing for feasible adoption and dissemination to other institutions with similar EHR capabilities. Lastly, we will address malpractice risk by investigating a strategic intervention aimed at reducing known contributors to patient harm during IHT, a high-risk transition in care that involves transfer of high-acuity patients between providers, settings and systems of care.

Description:

Inter-hospital transfer (IHT), commonly performed to provide patients with more specialized care, involves transfer of patients between providers, settings and systems of care, leaving these patients vulnerable to the risks of discontinuity of care. Standardized communication tools, which have been successful at reducing patient harm among other similar hospital-based care transitions (i.e., intra-hospital patient handoffs), have been under-utilized during IHT to-date, leaving the process largely non-standardized and variable.

The overall goal of this proposal is to optimize patient safety during IHT to GMS, cardiology and oncology services, collectively comprising nearly 50% of all IHT to Brigham and Women's Hospital (BWH), by leveraging our pilot work to design, implement and rigorously evaluate a standardized communication tool to be used during IHT. We propose the following Specific Aims to accomplish this goal:

Aim 1. Utilize pilot data and stakeholder input to revise the standardized accept note.

Aim 2a. Implement the revised standardized accept note for all patients transferred from another acute care hospital to the GMS, cardiology, and oncology inpatient services at BWH.

Aim 2b. Shift the responsibility of documentation of the accept note from a diffuse group of individual clinicians to a small group of dedicated nurses within the Access Center.

Aim 3. Prospectively evaluate the impact of the intervention on patient safety outcomes, including: clinician-reported medical errors and adverse events, length of stay after transfer, rapid-response or code within 6-hours of transfer, ICU-transfer within 24-hours of transfer, and 3-day and in-hospital mortality.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 1188
• Est. completion date: June 30, 2023
• Est. primary completion date: July 15, 2022
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• source of admission is inpatient transfer from another acute care hospital

• admitted to general medical service

• admitted to cardiology service

• admitted to oncology service

• admitted to ICU service

• age >= 18

Exclusion Criteria:

• source of admission is other than inpatient transfer

• admitted to service other than listed above

• age < 18

Related Conditions & MeSH terms

• Disease
• Inpatient Facililty Diagnoses

Intervention

Other:
• New Standardized Accept Note
A standardized accept note for transfer patients will be implemented, after stakeholder engagement and subsequent finalization.
• Existing Transfer Patient Admission Process
Maintain existing transfer patient admission processes, across GMS, Cardiology, and Oncology services.

Locations

Country	Name	City	State
United States	Brigham & Women's Hospital	Boston	Massachusetts

Sponsors (2)

Lead Sponsor	Collaborator
Brigham and Women's Hospital	Crico

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	clinician-reported medical errors and adverse events	Medical errors and adverse events measured as the total number of medical errors per patient	Up to 2 weeks
Secondary	Presence of any adverse event after transfer	Clinician reported adverse events for each transferred patient	up to 2 weeks
Secondary	Preventable adverse event after transfer		up to 2 weeks
Secondary	Ameliorable adverse event after transfer		up to 2 weeks
Secondary	Length of stay of hospitalization after transfer		up to 2 weeks
Secondary	ICU-transfer within 24 hours of transfer		Up to 24 hours
Secondary	In-hospital mortality		up to 30 weeks
Secondary	presence of accept note		Up to 24 hours
Secondary	timeliness of accept note		Up to 24 hours