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

Renee Fekieta, Alana Rosenberg, Beth Hodshon, Shelli Feder, Sarwat I. Chaudhry and Beth L. Emerson

Health Systems, 2021, vol. 10, issue 4, 239-248

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.

Date: 2021
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DOI: 10.1080/20476965.2020.1768807

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