SHM Converge Scientific Abstract ePoster Gallery-Identification of Potentially Inappropriate Inter-Hospital Transfer

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The document describes a study on inter-hospital transfer (IHT), which is the transfer of patients between acute care hospitals. The main concern is that some patients may undergo transfer despite limited benefit and avoidable risk, but it is unclear how to identify “inappropriate” transfers.<br /><br />To address this, the researchers gathered input from multiple stakeholders to:  <br />1) build a conceptual model of how transfer decisions are made, and  <br />2) create a consensus definition of potentially inappropriate IHT.<br /><br />They conducted 7 focus groups with 39 participants from 13 partner sites across the U.S., including hospital leadership, accepting clinicians, transferring clinicians, and patient-family advisory council members. Using guided discussion of five clinical scenarios, they explored when transfers were appropriate, as well as environmental factors that influence decisions, such as institutional relationships, alternatives to transfer, and patient/family dissatisfaction. The interviews were transcribed, deidentified, and coded into themes and subthemes.<br /><br />Based on the findings, the team developed a conceptual model of patient selection for transfer and a definition of potentially inappropriate IHT. A transfer was considered potentially inappropriate if the patient’s need could have been managed by an alternative to transfer, could have been managed at the transferring hospital, and/or was non-urgent.<br /><br />These concepts were turned into an adjudication tool with questions about alternatives to transfer, whether the needed care was unavailable at the transferring hospital, and whether the need was urgent. The tool rates transfer appropriateness from highly inappropriate to highly appropriate.<br /><br />Next, the researchers plan to review 1,800 charts across 18 hospitals to measure the prevalence of inappropriate IHT and develop best-practice recommendations to prevent it.

Asset Subtitle

Caitlin M. Kelly

Meta Tag

Author List Caitlin M. Kelly, James D. Harrison, Luci K. Leykum, Stephanie K. Mueller

Category Innovations

Concept Pediatric Inter-Hospital Transfer

Concept Potentially Inappropriate Transfer

Concept Patient Selection

Concept Availability of Care

Concept Adjudication Framework

Distinguished Non-Finalist

Presenter Organization Brigham and Women's Hospital

Presenting Author Caitlin M. Kelly

Track Transitions of Care

Keywords

inter-hospital transfer

acute care hospitals

patient transfer

inappropriate transfer

transfer decision-making

conceptual model

focus groups

clinical scenarios

adjudication tool

hospital transfer appropriateness

Pediatric Inter-Hospital Transfer

Potentially Inappropriate Transfer

Patient Selection

Availability of Care

Adjudication Framework