Inter-Hospital Transfer Safety Concerns

Introduction

The modern health care sector faces multiple problems related to the provision of care to patients in appropriate ways and preservation of the high quality of their lives. The increased complexity of cases that are observed today along with the high level of requirements to outcomes demands the use of diverse approaches to treat patients and guarantee their recovery. However, different hospitals have various opportunities for diagnosing and supporting patients in their recovery. Under these conditions, the problem of inter-hospital patients emerge. The necessity to transfer one client to another facility can be explained by the existence of better conditions for the provision of care; at the same time, multiple safety concerns emerge because of many risks decreasing the quality of services and deteriorating outcomes. The lack of communication and poor organization of documentation can result in mishaps and emergence of undesired results or even lethal cases. For this reason, the given literature review is devoted to the investigation of the problem of inter-hospital patients as one of the most topical issues nowadays.

The in-depth analysis of the given research question can contribute to the improved understanding of how better results can be achieved. It means that it is critical to take into account all existing problems and challenges related to patients’ transfer and discuss measures that can minimize risks. For this reason, the paper offers the following PICO question:

In the inter-hospital transfer, are patients kept safe with complete care versus safety concerns occurring due to lack of communication and documentation resulting in mishaps?

Background

The relevance of the selected topic is evidenced by several facts. First, one should correctly realize the fact that transportation of patients between medical facilities without the interruption of treatment and deterioration of outcomes is an extremely challenging task (Kiss, Bolke, & Spieth, 2017). The success of this process depends on the correct organization of inter-hospital transport and all documents that are needed to inform specialists about the peculiarities of the case and how a certain should be treated (Kiss et al., 2017). It also demands the high qualification of teams, innovative and effective equipment, and high standards to manage possible adverse effects before, during, and after the transport (Kiss et al., 2017).

The complexity increases because of the involvement of multiple actors responsible for the project as the hospital of origin has to correctly identify and diagnose transfer-eligible patients preparing them for the process (Kiss et al., 2017). At the same time, destination hospital should be ready to meet a patient and create all needed infrastructure, specialists, and consider all accompanying factors (Kiss et al., 2017). That is why the work with documentation that supports negotiations between hospitals becomes a critical factor affecting the results of the whole process. It can be improved via checklists, specific education, and improved negotiation techniques between main actors.

Lack of Education, Training, and Preparedness

Speaking about the problem of these transports, Eiding, Kongsgaard, and Braarud (2019) also emphasize the fact that there is no consensus on how patients should be transferred, which results in the emergence of multiple challenges. Using results of 20 semi-structured interviews of doctors, nurses, and other health workers, they come to the conclusion that in the majority of cases the transports are classified as potentially unsafe for both patients and specialists (Eiding et al., 2019). First of all, there is a critical lack of standardization related to this procedure, which results in the emergence of multiple misunderstandings and mishaps at different stages (Eiding et al., 2019). Additionally, the personnel emphasized the existence of significant differences between the prehospital working environment and in-hospital setting as one of the important factors influencing inter-hospital patients (Eiding et al., 2019). Furthermore, Eiding et al. (2019) outline the absence of systematic education, preparedness, and effective checklists, which can also introduce poor outcomes (Eiding et al., 2019). These findings show the existence of the critical need for improvement in the given sphere.

Information Handover

The increased importance of additional training and effective transfer systems is also discussed by Fairclough, FitzMaurice, Lewis, and Guha (2017) who try to determine factors that can reduce mortality and morbidity rates in inter-hospital patients. They conducted a multi-professional study collecting both qualitative and quantitative data from patients and junior physicians via surveys and analysis of reports (Fairclough et al., 2017). The results echo findings of the previous study as 95,5% present of doctors consider the existing system of patients transfer unsafe because of critical drawbacks and poor communication or information sharing practices (Fairclough et al., 2017). Instructions’ handover and provision of appropriate documentation are usually organized on low levels, which means that there is an increased risk of possible complications and undesired adverse effects. For this reason, Fairclough et al. (2017) draw attention to the fact that one of the effective ways to improve outcomes and reduce risks is the development of a standardized online-transfer system that will help to avoid poor medical information handover and guarantee safety to all inter-hospital patients.

Effective Handoff Practices

The problem of interhospital transfer handoff is also touched by Herrigel et al. (2016) as one of the topical issues of the modern healthcare sector. The major motif for the appearance of multiple investigations of the problem is that it still remains not well described as the best practices and existing trends remain unclear. That is why there is the critical need for the identification of the most effective handoff interhospital strategies to avoid corruption of data and deterioration of results. Evaluating data of 32 tertiary care centers in the USA, Herrigel et al. (2016) conclude that there is a wide variety of instructions, practices, and protocols that are used during the transfer. In many cases, it results in the emergence of confusions and misunderstandings that have a negative impact on outcomes. On the contrary, effective approaches and handoff practices remain unnoticed or given little attention while they can significantly reduce undesired results and reduce errors preconditioned by poorly organized documentation or information sharing. Herrigel et al. (2016) are sure that the further analysis of these methods and their evaluation is the key to the achievement of success regarding the outlined problem. In general, the study proves the existence of negative trends in the selected sphere.

Conclusion

Altogether, relevant studies evidence that the interhospital transfer and safety of patients during this process remain a serious problem for the modern healthcare sector. The existing drawbacks in the organization include poor information handover and sharing practices, the absence of standardized approaches, poor preparedness levels, pressure on specialists, and the inability to negotiate effectively. All these factors result in the appearance of serious risks related to patients’ transfers and outcomes. That is the there is a critical need for further investigation of the question to find possible solutions to achieve improvements.

References

Eiding, H., Kongsgaard, U., & Braarud, A-C. (2019). Interhospital transport of critically ill patients: Experiences and challenges, a qualitative study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 27, 27. Web.

Fairclough, G., FitzMaurice, T., Lewis, M., & Guha, A. (2017). Avoidance of mortality and morbidity in inter-hospital transfers. Patient Safety and Quality Improvement Journal, 5(4), 601-605.

Herrigel, D., Carroll, M., Fanning, C., Steinberg, M., Parikh, A., & Usher, M. (2016). Interhospital transfer handoff practices among US tertiary care centers: A descriptive survey. Journal of Hospital Medicine, 11(6), 413-417. Web.

Kiss, T., Bolke, A., & Spieth, P. (2017). Interhospital transfer of critically ill patients. Minerva Anestesiologica, 83(10), 1101-1108. Web.