School of Medicine and Health Sciences Poster Presentations

Title

Improving the One Call Inter-Hospital Transfer System to Improve Patient Safety and Efficiency of Care: An Update

Document Type

Poster

Abstract Category

Quality Improvement

Keywords

hospital transfer, communication, physician evaluation, triage

Publication Date

Spring 5-1-2019

Abstract

Introduction: As a tertiary care center, George Washington University Hospital accepts transfers from regional hospitals for patients who require a higher level of care. These patients are often at increased risk of morbidity and mortality due to their clinical state. However, since these patients are admitted directly, they bypass the well-developed triaging systems that are in place in the emergency department, creating significant patient safety concerns surrounding this admission system. In the 2017-2018 academic year, a project was undertaken with the goal of expediting time-to-evaluation (as measured by time-to-admission order) by the medical admitting residents. Methods: During the initial project, key stakeholders (including medical residents, nurses, charge nurses, nursing administration, and the Patient Logistics Center, or PLC) were engaged to develop a protocol for notifying admitting residents when patients arrived to the hospital, consisting of PLC staff sending a TigerText message to the admitting resident at the time of arrival. The result of this intervention was a statistically significant decrease in time-to-admission order by 50% with a protocol utilization rate of 57%. In order to continue improving the project, a first PDSA cycle was implemented to remeasure baseline data after 4 months of adopted protocol utilization. Further PDSA cycles included re-education regarding the protocol workflow and real-time weekly feedback on rates of protocol utilization. The primary outcome measured was the rate of protocol adoption with an aim to increase it by 50% from baseline. Results: Baseline protocol utilization was 0% after 4 months of implementation of the protocol. This rate increased from 0% (for 31 patients) to 27.6% (24 TigerTexts for 87 patients). Time-to-admission order increased from 67.9 minutes to 112.9 minutes, an increase from the baseline for the second phase of the project as well as from initial data in April 2018. Conclusions: While initial data suggested that the protocol could reduce time from admission to physician evaluation significantly, later PDSA cycles revealed that this protocol was ultimately unsustainable in terms of consistent utilization, raising concerns regarding its ability to consistently reduce time-to-evaluation in the long term. Future PDSA cycles may focus on implementing an alternate mechanism or protocol for notifying admitting physicians of a patient's arrival in order to a) reduce time-to-admission-order metrics and b) improve morbidity and mortality associated with this transition of care.

Open Access

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Presented at Research Days 2019.

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Improving the One Call Inter-Hospital Transfer System to Improve Patient Safety and Efficiency of Care: An Update

Introduction: As a tertiary care center, George Washington University Hospital accepts transfers from regional hospitals for patients who require a higher level of care. These patients are often at increased risk of morbidity and mortality due to their clinical state. However, since these patients are admitted directly, they bypass the well-developed triaging systems that are in place in the emergency department, creating significant patient safety concerns surrounding this admission system. In the 2017-2018 academic year, a project was undertaken with the goal of expediting time-to-evaluation (as measured by time-to-admission order) by the medical admitting residents. Methods: During the initial project, key stakeholders (including medical residents, nurses, charge nurses, nursing administration, and the Patient Logistics Center, or PLC) were engaged to develop a protocol for notifying admitting residents when patients arrived to the hospital, consisting of PLC staff sending a TigerText message to the admitting resident at the time of arrival. The result of this intervention was a statistically significant decrease in time-to-admission order by 50% with a protocol utilization rate of 57%. In order to continue improving the project, a first PDSA cycle was implemented to remeasure baseline data after 4 months of adopted protocol utilization. Further PDSA cycles included re-education regarding the protocol workflow and real-time weekly feedback on rates of protocol utilization. The primary outcome measured was the rate of protocol adoption with an aim to increase it by 50% from baseline. Results: Baseline protocol utilization was 0% after 4 months of implementation of the protocol. This rate increased from 0% (for 31 patients) to 27.6% (24 TigerTexts for 87 patients). Time-to-admission order increased from 67.9 minutes to 112.9 minutes, an increase from the baseline for the second phase of the project as well as from initial data in April 2018. Conclusions: While initial data suggested that the protocol could reduce time from admission to physician evaluation significantly, later PDSA cycles revealed that this protocol was ultimately unsustainable in terms of consistent utilization, raising concerns regarding its ability to consistently reduce time-to-evaluation in the long term. Future PDSA cycles may focus on implementing an alternate mechanism or protocol for notifying admitting physicians of a patient's arrival in order to a) reduce time-to-admission-order metrics and b) improve morbidity and mortality associated with this transition of care.