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Observational Study
. 2016 Dec:36:240-245.
doi: 10.1016/j.jcrc.2016.08.006. Epub 2016 Aug 10.

Information handoff and outcomes of critically ill patients transferred between hospitals

Michael G Usher  1 , Christine Fanning  2 , Di Wu  2 , Christine Muglia  2 , Karen Balonze  2 , Deborah Kim  3 , Amay Parikh  4 , Dana Herrigel  2
Affiliations
Observational Study

Information handoff and outcomes of critically ill patients transferred between hospitals

Michael G Usher et al. J Crit Care. 2016 Dec.

Abstract

Purpose: Patients transferred between hospitals are at high risk of adverse events and mortality. This study aims to identify which components of the transfer handoff process are important predictors of adverse events and mortality.

Materials and methods: We conducted a retrospective, observational study of 335 consecutive patient transfers to 3 intensive care units at an academic tertiary referral center. We assessed the relationship between handoff documentation completeness and patient outcomes. The primary outcome was in-hospital mortality. Secondary outcomes included adverse events, duplication of labor, disposition error, and length of stay.

Results: Transfer documentation was frequently absent with overall completeness of 58.3%. Adverse events occurred in 42% of patients within 24 hours of arrival, with an overall in-hospital mortality of 17.3%. Higher documentation completeness was associated with reduced in-hospital mortality (odds ratio [OR], 0.07; 95% confidence interval [CI], 0.02 to 0.38; P = .002), reduced adverse events (coefficient, -2.08; 95% CI, -2.76 to -1.390; P < .001), and reduced duplication of labor (OR, 0.19; 95% CI, 0.04 to 0.88; P = .033) when controlling for severity of illness.

Conclusions: Documentation completeness is associated with improved outcomes and resource utilization in patients transferred between hospitals.

Keywords: Handoff; ICU mortality; Information; Interhospital transfer; Transitions of care.

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Conflict of interest statement

No conflict of interests for any author.

Figures

Figure 1
Figure 1. Variation in transfer documentation and patient disposition
a) There was no relationship between documentation volume and information content, independent of whether patients were transferred from a referring ICU or ED. b,c) despite a circadian distribution of transfer initiation, patient arrival occurred more frequently at night.
See this image and copyright information in PMC

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