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

From the Guidelines

To improve the transfer of patients for higher level care, healthcare facilities should prioritize implementing a standardized communication protocol, such as SBAR, and establishing clear transfer criteria using objective physiological parameters, as recommended by the most recent guidelines 1. This approach ensures that critical information is consistently conveyed between care teams, reducing communication failures and standardizing decision-making. Key strategies to improve patient transfer include:

• Implementing rapid response teams to quickly assess and facilitate transfers for deteriorating patients
• Developing formal transfer agreements with receiving facilities to outline responsibilities, documentation requirements, and communication expectations
• Using standardized transfer documentation forms to capture essential patient information, including current medications with doses, recent interventions, and response to treatments
• Regular interdisciplinary training sessions on transfer protocols, including simulation exercises for high-risk scenarios, to improve team performance during actual transfers
• Leveraging technology solutions, such as electronic health record integration between facilities and telemedicine consultation capabilities, to expedite transfers and allow receiving teams to review patient data before arrival
• Implementing post-transfer debriefings and quality improvement reviews to identify system issues and refine processes over time, as suggested by the guidelines for safe transfer of brain-injured patients 1. The guidelines from the Association of Anaesthetists and the Neuro Anaesthesia and Critical Care Society 1 emphasize the importance of sound principles in transferring patients with brain injury, including avoiding secondary brain injury due to cerebral hypoxia, and highlight the need for prompt admission to a regional neurosurgical unit for life-saving, emergency surgery. By prioritizing these evidence-based strategies, healthcare facilities can reduce morbidity, mortality, and improve quality of life for patients requiring higher level care, as supported by the guidelines for managing transitions of care following stroke 1 and the guidelines for the early management of patients with acute ischemic stroke 1.

From the Research

Evidence-Based Strategies for Transferring Patients

To improve the transfer of patients for a higher level of care, several evidence-based strategies can be employed. These strategies focus on standardizing the transfer process, improving communication, and ensuring patient safety.

• Standardization of Transfer Process: Studies have identified critical elements of the transfer process that need standardization, 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 2.
• Improvement of Patient Transfer Time: Implementing a phased approach to improve patient transfer time has been shown to reduce transfer time from the ICU to the Medical/Surgical Floor and decrease the number of patients experiencing extreme delays 3.
• Effective Communication: The use of videophones and communication checklists can facilitate the transfer of information, responsibility, and control between sending and receiving clinicians, ensuring effective management of interdependencies during the transfer process 4.
• Allocation of Resources: Allocating a crash bed and engaging sending, receiving, and consulting teams in the physical movement of patients can help address challenges related to patient transfer 4.
• In-Hospital Transfer Protocols: Establishing in-hospital transfer protocols can help standardize the transfer process and ensure patient safety 4.
• Quality Improvement Initiatives: Implementing quality improvement initiatives, such as assessing and improving transfer notes, can help optimize patient safety during transfers 5.
• Fluid Resuscitation and Vasopressor Support: In severe trauma patients, fluid resuscitation and vasopressor support should be balanced to prevent excessive fluid resuscitation and promote patient safety 6.