Optimizing the Safety of Inter-Hospital Transfer

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.

Study Overview

• Status: Completed
• Conditions: Inpatient Facililty Diagnoses
• Intervention / Treatment: Other: Existing Transfer Patient Admission Process; Other: New Standardized Accept Note

Detailed Description

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.

Aim 3. Prospectively evaluate the impact of the intervention on patient safety outcomes, including: clinician-reported medical errors and adverse events, length of stay after transfer, rapid-response or code within 6-hours of transfer, ICU-transfer within 24-hours of transfer, and 3-day and in-hospital mortality.

• Study Type: Interventional
• Enrollment (Actual): 1658
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Massachusetts
    • Boston, Massachusetts, United States, 02115
      • Brigham & Women's Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• 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

Exclusion Criteria:

• source of admission is other than inpatient transfer
• admitted to service other than listed above
• age < 18

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: 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.	Other: Existing Transfer Patient Admission Process; Maintain existing transfer patient admission processes, across GMS, Cardiology, and Oncology services.
Experimental: 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.	Other: New Standardized Accept Note; A standardized accept note for transfer patients will be implemented, after stakeholder engagement and subsequent finalization.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
clinician-reported medical errors and adverse events	Medical errors and adverse events measured as the total number of medical errors per patient	Up to 2 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Presence of any adverse event after transfer	Clinician reported adverse events for each transferred patient	up to 2 weeks
Preventable adverse event after transfer		up to 2 weeks
Ameliorable adverse event after transfer		up to 2 weeks
Length of stay of hospitalization after transfer		up to 2 weeks
ICU-transfer within 24 hours of transfer		Up to 24 hours
In-hospital mortality		up to 30 weeks
presence of accept note		Up to 24 hours
timeliness of accept note		Up to 24 hours

Collaborators and Investigators

• Sponsor: Brigham and Women's Hospital
• Collaborators: Crico
• Investigators: Principal Investigator: Stephanie Mueller, M.D., M.P.H., Brigham and Women's Hospital

Study record dates

Study Major Dates

• Study Start (Actual): August 17, 2020
• Primary Completion (Actual): July 15, 2022
• Study Completion (Actual): June 30, 2023

Study Registration Dates

• First Submitted: April 6, 2023
• First Submitted That Met QC Criteria: May 23, 2023
• First Posted (Actual): May 25, 2023

Study Record Updates

• Last Update Posted (Actual): January 23, 2026
• Last Update Submitted That Met QC Criteria: January 21, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease
• Other Study ID Numbers: 2020P001945

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No