SHM Converge Scientific Abstract ePoster Gallery-Creation of a Centralized Accept Note to Improve Communication During Inter-Hospital Transfer (Iht)

Pdf Summary

This project addressed communication problems during inter-hospital transfers (IHT), where discontinuity of care can lead to missing information, poor communication, and clinical uncertainty. Prior work at Brigham and Women’s Hospital found that IHT information was often suboptimal, with 31% of cases rated “poor” or “fair,” 35% missing important clinical details, and 22% leaving clinicians uncertain about management.<br /><br />To improve this process, a multidisciplinary working group of resident and attending physicians, advanced practice providers, Access Center nurses, and Access Center leadership met from September 2020 to June 2021. The team used process mapping to identify barriers and solutions, then created a standardized “accept note” template for patients transferred from outside hospitals to general medicine, cardiology, and oncology services. The template was based on the IPASS format, which clinicians were already familiar with. It was built into the EPIC electronic health record as a dot phrase for easy use, and Access Center nurses were trained during a wash-in phase in June-July 2021.<br /><br />The main barrier changes addressed were simplifying a cumbersome prior template, avoiding delays by limiting documentation to information available during the verbal handoff, and guiding clinicians to where full transfer documents could be found in the EHR.<br /><br />Accept note completion improved from 54.8% during baseline to 80.3% during the intervention period through December 1, 2021. The authors believe this improvement was due to easier completion and better training/focus.<br /><br />Next steps include evaluating effects on clinician-reported information quality, medical errors, adverse events, hospital length of stay, rapid response events, ICU transfers, and mortality, as well as expanding the template to other services.

Asset Subtitle

Stephanie K. Mueller

Meta Tag

Author List David Clossey, Eric Goralnick, Jeffrey L. Schnipper, Leslie Grignaffini, Maria Murray, Marissa Cauley, Stephanie K. Mueller

Category Innovations

Concept Pediatric Inter-Hospital Transfer

Concept Care Transition

Concept Continuity of Care

Concept Accept Note

Concept I-PASS

Distinguished Non-Finalist

Presenter Organization Brigham and Women's Hospital

Presenting Author Stephanie K. Mueller

Track Transitions of Care

Keywords

inter-hospital transfers

communication

care continuity

accept note template

IPASS format

EPIC electronic health record

process mapping

Access Center nurses

clinical handoff

documentation improvement

Pediatric Inter-Hospital Transfer

Care Transition

Continuity of Care

Accept Note

I-PASS