Difference between revisions of "Dealing with Patient Transfers"

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CPOE may facilitate information transfer by being the primary data capture point during the care transition process. Medical information transfer is now routinely performed by “sign-outs” between physicians. Accuracy, flexibility, and portability are identified as key elements. Standardization of information necessary for safe patient transfer may include active medical problems, active medications, code status, important labs, pending studies, etc. Computerization of sign-outs can help organize the transfer of vital patient information (Ref 5). Finally, implementation of a computerized process at a point which promotes optimal workflow should enhance safety while retaining usability.  
 
CPOE may facilitate information transfer by being the primary data capture point during the care transition process. Medical information transfer is now routinely performed by “sign-outs” between physicians. Accuracy, flexibility, and portability are identified as key elements. Standardization of information necessary for safe patient transfer may include active medical problems, active medications, code status, important labs, pending studies, etc. Computerization of sign-outs can help organize the transfer of vital patient information (Ref 5). Finally, implementation of a computerized process at a point which promotes optimal workflow should enhance safety while retaining usability.  
  
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Anuj K Dalal, M.D.
  
 
'''References'''
 
'''References'''

Revision as of 20:09, 12 November 2007

Background

Patient transfers are a critical time during hospitalization. Errors across the continuum of care account for 13% of all sentinel events reported to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (Ref 1). Medical errors related to care transitions are an area of concern and are specifically targeted by JCAHO’s National Patient Safety Goal to "accurately and completely reconcile medications across the continuum of care" (Ref 2).


Patient Transfer Process

Patient transfers occur during hospital admission from the emergency room, transfer between different services (i.e. medical, surgical, sub-specialty), and transfer between different levels of care (i.e. intensive care unit to general medical ward, operating room to recovery unit, etc.)

The transfer process should include the following elements:

1) Determination if transfer will require a change of service and/or providers.

2) Determination if transfer will require an alternative level of care.

3) Communication of information to the accepting providers, if necessary.

4) Review of medications and non-medication orders.

5) Reconciliation of medication and non-medication orders.

6) Writing and/or discontinuing orders prior to patient transfer.

7) Physical transfer of patient to new location, if necessary.

8) Update patient status in clinical information system(s) with all relevant information relating to transfer.


How can CPOE help?

CPOE can facilitate and promote safe patient transfer practices with respect to the medication review and reconciliation. For example, Poon et al describe an effort to leverage their institutions available information systems to develop an integrated application supporting medication reconciliation across the spectrum of patient care activities from admission to discharge (Ref 4). CPOE may perform the same reconciliation function with respect to non-medication orders as well.

CPOE may facilitate information transfer by being the primary data capture point during the care transition process. Medical information transfer is now routinely performed by “sign-outs” between physicians. Accuracy, flexibility, and portability are identified as key elements. Standardization of information necessary for safe patient transfer may include active medical problems, active medications, code status, important labs, pending studies, etc. Computerization of sign-outs can help organize the transfer of vital patient information (Ref 5). Finally, implementation of a computerized process at a point which promotes optimal workflow should enhance safety while retaining usability.

Anuj K Dalal, M.D.

References

1. http://www.jcipatientsafety.org/fpdf/psp/PatientSafetyArticles/S3-PS-02-03.pdf

2. http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/

3. http://www.jcipatientsafety.org/14711/

4. Poon et al. Design and Implementation of an Application and Associated Services to Support Interdisciplinary Medication Reconciliation Efforts at an Integrated Healthcare Delivery Network. J Am Med Inform Assoc. 2006;13:581-592

5. Organizing the transfer of patient care information: the development of a computerized resident sign-out system. Surgery. Jul 2004;136:5-13