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Journal of general internal medicine
Mar 27, 2025;

Development of a Tool to Measure Potentially Inappropriate Inter-Hospital Transfer (IHT): The POINT Study.

Stephanie K Mueller, Caitlin Kelly, Stephanie Singleton, Luci K Leykum, James D Harrison, Andrew Auerbach, Jeffrey Schnipper
Author Information
  1. Stephanie K Mueller: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
  2. Caitlin Kelly: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA. ckelly41@bwh.harvard.edu. ORCID
  3. Stephanie Singleton: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
  4. Luci K Leykum: South Texas Veterans Health Care System, San Antonio, USA.
  5. James D Harrison: Division of Hospital Medicine, University of California San Francisco, San Francisco, USA.
  6. Andrew Auerbach: Division of Hospital Medicine, University of California San Francisco, San Francisco, USA.
  7. Jeffrey Schnipper: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
PMID: 40146412 DOI: 10.1007/s11606-024-09221-8

Abstract

BACKGROUND: Although inter-hospital transfer (IHT, the transfer of patients between acute care hospitals) aims at matching patients' care needs to appropriate sites of care, IHT practices are variable leaving some patients vulnerable to risks of discontinuity of care without clear benefit. Identifying which patients may not need IHT can help to prevent inappropriate care and improve patient outcomes.
STUDY OVERVIEW: The POINT Study, "Identification and Prevention of Potentially Inappropriate Inter-Hospital Transfers," is a 5-year study (AHRQ-R01HS028621) that aims to define potentially inappropriate IHT using key stakeholder input, evaluate the incidence and patient safety impact of potentially inappropriate IHT across a nationally representative sample of 18 hospitals, and develop an intervention toolkit to reduce potentially inappropriate IHT. In this paper, we report on the development of a standardized adjudication process to capture potentially inappropriate IHT using results generated from the first 2 years of this project.
DEVELOPMENT OF THE ADJUDICATION TOOL: Development of the adjudication tool to measure potentially inappropriate IHT involved a multi-step process, including (1) conducting focus groups of key stakeholders involved in IHT to generate a consensus definition of "potentially inappropriate IHT;" (2) translating this definition into an adjudication tool for use during retrospective chart review; and (3) conducting rigorous training among all adjudicators to ensure reliability of the adjudication process.
NEXT STEPS: Next steps include launching sites to conduct adjudications with a goal of 1800 total transfer case adjudications across the 18 sites. We will support the adjudication process with monthly tracking and case review meetings among other supports. The results of this work will lead to a foundational understanding of the prevalence, risk factors, and patient safety impact of potentially inappropriate IHT.

References

  1. Sokol-Hessner L, White AA, Davis KF, Herzig SJ, Hohmann SF. Interhospital transfer patients discharged by academic hospitalists and general internists: Characteristics and outcomes. J Hosp Med. 2015.
  2. Mueller SK, Zheng J, Orav EJ, Schnipper JL. Rates, Predictors and Variability of Interhospital Transfers: A National Evaluation. J Hosp Med. 2017;12(6):435-442. [DOI: 10.12788/jhm.2747]
  3. Mueller SK, Shannon E, Dalal A, Schnipper JL, Dykes P. Patient and Physician Experience with Interhospital Transfer: A Qualitative Study. J Patient Saf. 2018.
  4. Wagner J, Iwashyna TJ, Kahn JM. Reasons underlying interhospital transfers to an academic medical intensive care unit. J Crit Care. 2013;28(2):202-208. [DOI: 10.1016/j.jcrc.2012.07.027]
  5. Bosk EA, Veinot T, Iwashyna TJ. Which patients and where: a qualitative study of patient transfers from community hospitals. Med Care. 2011;49(6):592-598. [DOI: 10.1097/MLR.0b013e31820fb71b]
  6. Centers for Medicare & Medicaid Services: Emergency Medical Treatment & Labor Act (EMTALA). https://www.cms.gov/regulations-and-guidance/legislation/emtala/ . Accessed October 10, 2019.
  7. Herrigel DJ, Carroll M, Fanning C, Steinberg MB, Parikh A, Usher M. Interhospital transfer handoff practices among US tertiary care centers: A descriptive survey. J Hosp Med. 2016;11(6):413-417. [DOI: 10.1002/jhm.2577]
  8. Mueller S, Zheng J, Orav EJP, Schnipper JL. Inter-hospital transfer and patient outcomes: a retrospective cohort study. BMJ Qual Saf. 2018.
  9. Huntington CR, Cox TC, Blair LJ, et al. Acuity, outcomes, and trends in the transfer of surgical patients: a national study. Surg Endosc. 2016;30(4):1301-1309. [DOI: 10.1007/s00464-015-4361-0]
  10. Heincelman M, Gebregziabher M, Kirkland E, et al. Impact of Patient-Level Characteristics on In-hospital Mortality After Interhospital Transfer to Medicine Services: an Observational Study. J Gen Intern Med. 2020;35(4):1127-1134. [DOI: 10.1007/s11606-020-05659-8]
  11. Rush B, Tyler PD, Stone DJ, Geisler BP, Walley KR, Celi LA. Outcomes of Ventilated Patients With Sepsis Who Undergo Interhospital Transfer: A Nationwide Linked Analysis. Crit Care Med. 2018;46(1):e81-e86. [DOI: 10.1097/CCM.0000000000002777]
  12. Gardner C, Rubinfeld I, Gupta AH, Johnson JL. Inter-Hospital Transfer Is an Independent Risk Factor for Hospital-Associated Infection. Surg Infect (Larchmt). 2024;25(2):125-132. [DOI: 10.1089/sur.2023.077]
  13. Mackie B, Kellett U, Mitchell M, Tonge A. The experiences of rural and remote families involved in an inter-hospital transfer to a tertiary ICU: a hermeneutic study. Aust Crit Care. 2014;27(4):177-182. [DOI: 10.1016/j.aucc.2014.04.004]
  14. Kazberouk A, Green A, Sharpe B, Wachter RM, Hoffman A. Right-Sizing Care: Transferring Lower-Acuity Patients from an Academic Medical Center to a Community Hospital. NEJM Catalyst. 2021;2(9).
  15. Centers for Disease Control and Prevention. National Center fo rHealth Statistics. Table 89. Hospitals, Beds, and Occupancy Rates, by Type of Ownership and Size of Hospital: United States, Selected Years 1975���2015. https://www.cdc.gov/nchs/data/hus/2017/089.pdf . Accessed October 12, 2021.
  16. J W, P S, R R, J P, L A. A Look at Rural Hospital Closures and Implications for Access to Care: Three Case Studies. 2016; https://files.kff.org/attachment/issue-brief-a-look-at-rural-hospital-closures-and-implications-for-access-to-care . Accessed July 25, 2024.
  17. Weissman GE, Crane-Droesch A, Chivers C, Mikkelsen ME, Halpern SD. Locally Informed Simulation to Predict Hospital Capacity Needs During the COVID-19 Pandemic. Ann Intern Med. 2020;173(8):680-681. [DOI: 10.7326/L20-1062]
  18. Mueller SK, Zheng J, Orav J, Schnipper JL. Interhospital Transfer and Receipt of Specialty Procedures. J Hosp Med. 2018;13(6):383-387. [DOI: 10.12788/jhm.2875]
  19. Mueller SK, Fiskio J, Schnipper J. Interhospital Transfer: Transfer Processes and Patient Outcomes. J Hosp Med. 2019;14:E1-E6. [DOI: 10.12788/jhm.3192]
  20. Donze JD, Williams MV, Robinson EJ, et al. International Validity of the HOSPITAL Score to Predict 30-Day Potentially Avoidable Hospital Readmissions. JAMA Intern Med. 2016;176(4):496-502. [DOI: 10.1001/jamainternmed.2015.8462]
  21. Aubert CE, Schnipper JL, Williams MV, et al. Simplification of the HOSPITAL score for predicting 30-day readmissions. BMJ Qual Saf. 2017;26(10):799-805. [DOI: 10.1136/bmjqs-2016-006239]
  22. Burke RE, Schnipper JL, Williams MV, et al. The HOSPITAL Score Predicts Potentially Preventable 30-Day Readmissions in Conditions Targeted by the Hospital Readmissions Reduction Program. Med Care. 2017;55(3):285-290. [DOI: 10.1097/MLR.0000000000000665]
  23. Auerbach AD, Kripalani S, Vasilevskis EE, et al. Preventability and Causes of Readmissions in a National Cohort of General Medicine Patients. JAMA Intern Med. 2016;176(4):484-493. [DOI: 10.1001/jamainternmed.2015.7863]
  24. Auerbach AD, Lee TM, Hubbard CC, et al. Diagnostic Errors in Hospitalized Adults Who Died or Were Transferred to Intensive Care. JAMA Intern Med. 2024;184(2):164-173. [DOI: 10.1001/jamainternmed.2023.7347]
  25. Auerbach AD, Patel MS, Metlay JP, et al. The Hospital Medicine Reengineering Network (HOMERuN): a learning organization focused on improving hospital care. Acad Med. 2014;89(3):415-420. [DOI: 10.1097/ACM.0000000000000139]
  26. Auerbach A, Schnipper J. UTILITY OF PREDICTIVE SYSTEMS TO IDENTIFY INPATIENT DIAGNOSTIC ERRORS: THE UPSIDE STUDY. In: Agency for Healthcare Research and Quality (AHRQ); 2019.
  27. Auerbach A, Schnipper J, Mueller SK. Hospital Medicine Reegineering Network COVID-19 Collaborative Research. In: Gordon E and Betty I Moore Foundation; 2020.
  28. Mueller SK. Identification and Prevention of Potentially Inappropriate Inter-Hospital Transfers (The POINT Study). In: Agency for Healthcare Research and Quality; 2022.
  29. Harrison JD, Anderson WG, Fagan M, et al. Patient and Family Advisory Councils (PFACs): Identifying Challenges and Solutions to Support Engagement in Research. Patient. 2018;11(4):413-423. [DOI: 10.1007/s40271-018-0298-4]
  30. Harrison JD, Auerbach AD, Anderson W, et al. Patient stakeholder engagement in research: A narrative review to describe foundational principles and best practice activities. Health Expect. 2019;22(3):307-316. [DOI: 10.1111/hex.12873]
  31. Hospital Medicine ReEngineering Network (HOMERuN) Patient & Family Advisory Council. https://hospitalinnovate.org/about-homerun/patient-family-advisory-council/ . Accessed August 15, 2024.
  32. Braun V, Clarke V. Thematic Analysis: A Practical Guide. 1st ed: Sage Publications; 2021.
  33. Byrne D. A worked example of Braun and Clarke���s approach to reflexive thematic analysis. Quality & Quantity. 2022;56(3):1391-1412. [DOI: 10.1007/s11135-021-01182-y]
  34. Kelly C, Yu A, Leykum L, Harrison J, Mueller SK. Identification of Potentially Inappropriate Inter-hospital Transfer. Paper presented at: Society of Hospital Medicine 2024; San Diego, CA.
  35. Levine DM, Ouchi K, Blanchfield B, et al. Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial. J Gen Intern Med. 2018;33(5):729-736. [DOI: 10.1007/s11606-018-4307-z]
  36. Mueller SK. Optimizing the Safety of Inter-Hospital Transfer. In: CRICO-RMF; 2020.
  37. Mueller S, Murray M, Goralnick E, et al. Implementation of a standardised accept note to improve communication during inter-hospital transfer: a prospective cohort study. BMJ Open Quality. 2023;12(4):e002518. [DOI: 10.1136/bmjoq-2023-002518]
  38. Dalal AK, Schnipper JL, Raffel K, Ranji S, Lee T, Auerbach A. Identifying and classifying diagnostic errors in acute care across hospitals: Early lessons from the Utility of Predictive Systems in Diagnostic Errors (UPSIDE) study. J Hosp Med. 2024;19(2):140-145. [DOI: 10.1002/jhm.13136]
  39. Schnipper JL, Raffel KE, Keniston A, et al. Achieving diagnostic excellence through prevention and teamwork (ADEPT) study protocol: A multicenter, prospective quality and safety program to improve diagnostic processes in medical inpatients. J Hosp Med. 2023;18(12):1072-1081. [DOI: 10.1002/jhm.13230]

Grants

  1. 1R01HS028621-01A1/Agency for Healthcare Research and Quality
Journal Article

Word Cloud

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