SHM Converge Scientific Abstract ePoster Gallery-Case Managers Boost Assent Rate for Interhospital Transfers in Comparison to Doctors

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This project addressed a common capacity problem at large academic medical centers (AMCs): overcrowded emergency departments and inpatient units. To help move appropriate lower-acuity patients to affiliated community hospitals, patient assent is required for transfer, but physician-led assent had been inconsistent and low, with success rates around 30–40%.<br /><br />UCSF developed a new workflow to improve assent for interfacility transfers. The intervention included:<br />- a standardized two-part script,<br />- training for three daytime ED case managers,<br />- and supporting materials such as an FAQ, pamphlets, and posters.<br /><br />The process was designed to socialize patients early. At ED arrival, patients received promotional materials and a case manager introduced the idea that, if admission was needed, care might continue at an affiliated community hospital. Once transfer eligibility was confirmed and a bed was arranged, the ED case manager asked for assent using the standardized script, emphasized that transport would be provided at no cost, answered questions, and shared written information.<br /><br />The pilot found that hospitalists often experienced internal conflict and competing demands when trying to obtain assent, which likely contributed to low and inconsistent performance. In contrast, during the 3-month pilot, case managers achieved an 86% assent success rate. The authors suggest this improvement may have been due to earlier patient preparation, greater consistency from a smaller trained group, and reduced perceived conflict of interest.<br /><br />Both hospitalists and case managers reported higher satisfaction with the new process. Future plans include extending the workflow to admitted floor patients who need assent for lateral transfer.

Asset Subtitle

Neal A. Tambe

Meta Tag

Author List Anne Ritchie, Bradley Monash, Charles Bell, Lukejohn W. Day MD, MBA, Maya Donnelly, Michelle S. Mourad, Molly Shane, Neal A. Tambe

Category Innovations

Concept Patient Transfer

Concept Assent

Concept Inpatient Capacity

Concept Assent Success Rate

Concept Emergency Department

Distinguished Non-Finalist

Presenter Organization UCSF Division of Hospital Medicine

Presenting Author Neal A. Tambe

Track Transitions of Care

Keywords

emergency department

inpatient overcrowding

interfacility transfer

patient assent

community hospitals

case managers

standardized script

workflow intervention

academic medical center

transfer satisfaction

Patient Transfer

Assent

Inpatient Capacity

Assent Success Rate

Emergency Department