Optimizing the Safety of Inter-Hospital Transfer
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 1,658
- 试验地点
- 1
- 主要终点
- clinician-reported medical errors and adverse events
研究概览
简要总结
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.
详细描述
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Sequential
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •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
排除标准
- •source of admission is other than inpatient transfer
- •admitted to service other than listed above
- •age < 18
研究组 & 干预措施
Pre-Intervention: Current Transfer Process
Control: Transfer patients are admitted per usual based on existing processes for GMS, Cardiology, and Oncology services. Data collection assesses clinician reported feedback on the logistics for each patient transfer, and issues along the transfer supply chain.
干预措施: Existing Transfer Patient Admission Process (Other)
Post-Intervention: Implementing Standardized Accept Note
Intervention Arm: After engaging stakeholders and finalizing a standardized accept note for transfer patients, appropriate staff will be trained on the use of the note and the note will be implemented in the transfer patient admission process. Data collection will assess clinician reported feedback on the logistics for each patient transfer, and issues along the transfer supply chain, post-intervention.
干预措施: New Standardized Accept Note (Other)
结局指标
主要结局
clinician-reported medical errors and adverse events
时间窗: Up to 2 weeks
Medical errors and adverse events measured as the total number of medical errors per patient
次要结局
- Ameliorable adverse event after transfer(up to 2 weeks)
- Presence of any adverse event after transfer(up to 2 weeks)
- Preventable adverse event after transfer(up to 2 weeks)
- Length of stay of hospitalization after transfer(up to 2 weeks)
- presence of accept note(Up to 24 hours)
- ICU-transfer within 24 hours of transfer(Up to 24 hours)
- In-hospital mortality(up to 30 weeks)
- timeliness of accept note(Up to 24 hours)
研究者
Stephanie Mueller
Associate Physician
Brigham and Women's Hospital