A Standardized transfer form improves communication between extended care facilities and the emergency department

Abstract

Study objectives: Lack of information in the emergency department (ED) adds to the complexity and difficulty of emergency patient care. Previous studies established that essential information is not consistently communicated during the transfer of extended care facility (ECF) patients to the ED. The Society for Academic Emergency Medicine Geriatric Emergency Medicine Task Force advised that emergency physicians be proactive in attempting to resolve this problem. The aim of our study is to improve communication between ECFs and EDs. We conduct a study to test the hypothesis that a standardized transfer form with essential data elements would increase the rate of successful documentation. Methods: The study design was a pre- and postintervention investigation. The intervention consisted of the introduction of a 1-page, standardized ECF-to-ED transfer form that listed 11 essential data elements. The completed form was then to be sent with patients transferred from the ECF to the ED. These 11 data elements were selected according to interviews with out-of-hospital personnel, ED nurses, and emergency physicians. The 11 essential elements and the data collected during the pre- and postintervention periods included the patient's name, date of birth, code status, social security number, usual mental status, usual functional status, and primary care physician; the ECF's name, charge nurse, and telephone number; and the reason for the transfer. The a priori definition for successful documentation was the documentation of 9 or more of the 11 essential data elements anywhere in the paperwork sent with the patient. The setting was the Methodist Hospital ED in Indianapolis, IN. Methodist Hospital is 1 of 2 teaching facilities that comprise the Indiana University School of Medicine Department of Emergency Medicine. Of the 94,000 patients treated annually in the Methodist ED, 14% are aged 65 years and older. The population included patients transferred by ambulance from ECFs to the ED. Before collecting data, we planned to (1) collect preintervention data on ECF-to-ED transfers, (2) identify the 10 ECFs with the most ED transfers, (3) implement the intervention in those ECFs, and (4) make comparisons between the pre- and postintervention periods for the 10 ECFs. In the statistical analysis, the effectiveness of the intervention was assessed by looking at the change in the percentage of transfers with successful documentation and in the mean number of documented items. The differences in these outcomes between the pre- and postintervention periods were estimated along with 95% confidence intervals (CIs) for the differences. This study was approved by the institutional review board. Results: Between April 15 and June 9, 2002, the ED received 130 transfers from 41 ECFs. Sixty-five of the 130 transfers were from 10 ECFs, which were then targeted for intervention. Thirty-eight (58.5%) of the 65 transfers successfully documented the essential data elements, with a mean of 8.7 (SD 1.6) of 11 data elements. In the postintervention period (October 2002 to January 2003), we studied 72 consecutive transfers from the 10 ECFs. Postintervention, the proportion of transfers with successful documentation was 77.8% (56 of 72), an increase of 19.3% (95% CI 4.0% to 34.7%); the mean number of essential data elements identified was 9.5 (SD 1.7), an increase of 0.8 data elements per transfer (95% CI 0.3 to 1.4 elements). In 23 (31.9%) of 72 postintervention transfers, the ECF-to-ED transfer form was transported with the patient to the ED. Successful documentation was achieved in 22 (95.6%) of the 23 postintervention transfers using the transfer form, an increase of 26.3% (95% CI 10.9% to 41.6%) compared with those transfers not using the form; the mean number of essential data elements was 10.7 (SD 0.8), an increase of 1.9 data elements (95% CI 1.1 to 2.6 elements) over transfers not using the form. Conclusion: Use of a standardized ECF-to-ED transfer sheet with 11 essential data elements on a single form increased the amount of essential data provided to the ED.