Organisational factors underpinning intra-hospital transfers: a guide for evaluating context in quality improvement

ABSTRACT

During intra-hospital transfers, multiple clinicians perform coordinated tasks that leave patients vulnerable to undesirable outcomes. Communication has been established as a challenge to care transitions, but less is known about the organisational complexities within which transfers take place. We performed a qualitative assessment that included various professions to capture a multi-faceted understanding of intra-hospital transfers. Ethnographic observations and semi-structured interviews were conducted with clinicians and staff from the Medical Intensive Care Unit, Emergency Department, and general medicine units at a large, urban, academic, tertiary medical centre. Results highlight the organisational factors that stakeholders view as important for successful transfers: the development, dissemination, and application of protocols; robustness of technology; degree of teamwork; hospital capacity; and the ways in which competing hospital priorities are managed. These factors broaden our understanding of the organisational context of intra-hospital transfers and informed the development of a practical guide that can be used prior to embarking on quality improvement efforts around transitions of care.

KEYWORDS:

• Patient transitions
• quality improvement
• context
• qualitative analysis

Acknowledgments

We are grateful to Judy Petersen, RN for her review and comments pertaining to an earlier draft of this paper.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was made possible by funding received from the Agency for Healthcare Research and Quality (P30HS023554) to support the Center for Healthcare Innovation, Redesign and Learning at the Yale University School of Medicine. The study was also supported by Yale New Haven Hospital (YNHH) and the Claude D. Pepper Older Americans Independence Center at Yale University School of Medicine (#P30AG021342 NIH/NIA). The content is solely the responsibility of the authors and does not necessarily represent the official views of these organizations.