Abstract 339: Quality of Physician Care Coordination During Inter-Facility Transfer for Cardiac Arrest Patients

Abstract

Objectives: We sought to evaluate whether the quality of coordination between physicians transferring comatose cardiac arrest survivors to a high-volume cardiac arrest center for targeted temperature management (TTM) was associated with timeliness of care. Methods: We conducted a retrospective analysis of inter-facility transfers to Vanderbilt University Medical Center for TTM between October 2016 and October 2018. We examined the relationship between Relational Coordination (RC) - a validated measure comprised of 7 dimensions of communication (frequency, timeliness, accuracy, problem solving) and relationship quality (respect, knowledge sharing, shared goals) - during recorded phone conversations between transferring and accepting physicians and time-to-acceptance. Investigators listened to recorded phone conversations and used a scoring guide to assign a score between 1 and 100 for each of the 7 dimensions of RC. Results: We identified 18 patients meeting criteria. TTM was initiated or continued in 72% (13 of 18). Median time-to-acceptance was 2.77 (interquartile range [IQR] 2.0, 4.1) minutes, and duration of calls was 3.95 (IQR 2.7, 5.2) minutes. Inter-rater reliability for overall RC was high (rho=0.87). The correlation between RC and the time-to-acceptance was significant in univariate analyses (adjusted relative risk=0.96, 95%CI 0.93, 1.0, p=0.05). Secondary analyses did not find a significant relationship between RC and timeliness measures. Conclusions: In this sample of patients transferred for TTM, we found that RC had a high inter-rater reliability. We also found that higher quality care coordination for cardiac arrest survivors was associated with faster physician acceptance. To better understand how the quality of care coordination impacts timeliness of care and patient outcomes, future work using a larger cohort should examine whether higher RC among a broader set of stakeholders (physicians, emergency medical services, families, etc.) is associated with timeliness measures after adjusting for other factors.