What are evidence-based strategies to improve transferring patients for a higher level of care?

From the Guidelines

Effective transfer of patients for higher levels of care requires a structured approach focusing on communication, standardization, and preparation, as emphasized in the most recent guidelines from 2020 1.

Key Strategies for Transfer

To minimize risks and improve outcomes, the following strategies should be implemented:

• Implementing the SBAR (Situation, Background, Assessment, Recommendation) communication technique during handoffs to reduce information loss and transfer-related errors.
• Standardized transfer protocols and checklists to ensure comprehensive documentation of vital signs, medication administration times, recent interventions, and response to treatments.
• Early identification of deteriorating patients using validated tools like the Modified Early Warning Score (MEWS) or National Early Warning Score (NEWS) for timely escalation of care.
• Complete transfer documentation should include the patient's full medical history, current medications with last administration times, allergies, code status, recent laboratory results, and imaging studies, as recommended by the Canadian Stroke Best Practice Recommendations 1.
• Designating a transfer coordinator or team to improve accountability and coordination between facilities.
• Pre-transfer stabilization is essential, including securing airways with appropriate equipment, establishing reliable IV access, and ensuring adequate medication supplies for transport, including emergency medications.

Importance of Timely Transfer

The guidelines from the Association of Anaesthetists and the Neuro Anaesthesia and Critical Care Society 1 highlight the importance of timely transfer, especially for patients with acute brain injury, to prevent secondary brain injury due to cerebral hypoxia.

Evidence-Based Recommendations

The American Heart Association/American Stroke Association guidelines 1 support the "drip-and-ship" model for acute stroke patients, where intravenous rtPA is initiated before transfer to a comprehensive stroke center, emphasizing the need for well-designed protocols and strict adherence to blood pressure guidelines.

Conclusion is not allowed, so the answer will be ended here.

From the Research

Evidence-Based Strategies for Transferring Patients to a Higher Level of Care

• Standardization of critical elements in the transfer process, including initiation of transfer request, management of transfer request and information exchange, updates between transfer acceptance and patient transport, transport, patient admission and information availability, and measurement, evaluation, and feedback, may improve the safety of interhospital transfers 2.
• Implementation of a phased approach to improve patient transfer time, including assessing the problem, identifying opportunities, testing ideas, and implementing successful ideas, can reduce patient transfer time and improve patient satisfaction scores 3.
• Use of evidence-based strategies, such as videophones and communication checklists, allocation of a crash bed, engagement of sending, receiving, and consulting teams in the physical movement of patients, and in-hospital transfer protocols, can address challenges related to transfer of information, responsibility, and control between sending and receiving clinicians 4.
• Quality improvement initiatives, such as assessing and improving transfer notes, can increase the completion rate and quality of transfer notes, facilitating better and safer care of patients moving from one unit to another 5.
• Patients who experience intra-hospital transfers to a higher level of care are known to have high mortality and excess length of stay, highlighting the need for effective strategies to improve patient outcomes in these situations 6.

Key Elements of Effective Transfer Processes

• Clear communication and information exchange between sending and receiving clinicians 2, 4.
• Standardization of transfer protocols and procedures 2, 3.
• Engagement of multidisciplinary teams in the transfer process 4.
• Use of technology, such as videophones and communication checklists, to facilitate information exchange and communication 4.
• Measurement, evaluation, and feedback to identify areas for improvement and monitor the effectiveness of transfer processes 2, 5.