Barriers to an Effective and Efficient Intra- and Inter-Establishment Transfer of Elderly Patients in Healthcare: A Scoping Review

Abstract

Introduction: An estimated 80% of consequential medical oversights originate from communication errors during patient hand-offs between clinical providers during inter-facility transfer. During the transfer, patients are at risk of receiving low quality, fragmented care plagued with inadequate communication and coordination across settings. Effective and efficient inter-establishment transfers are thus pivotal to safeguard the quality of care received by patients, thereby optimizing patient outcomes. Methods: To inform the limited literature on the barriers to an effective and efficient intra- and inter-establishment transfer of elderly patients in health care, a scoping review specific to the geriatric context was undertaken. Searches of three electronic databases (MEDLINE, CINAHL, and Scopus) were conducted between 15th September to 1st November 2021. 18 peer-reviewed English-written articles published between 2011 and 2021 were included in this review. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist and Arksey and O’Malley’s (2005) methodological approach for scoping reviews informed the writing of this review. Results: This review identified a total of 18 articles that discussed barriers to an effective and efficient inter-establishment transfer of elderly patients in healthcare. Three categories of barriers: individual-level, healthcare provider-level, and organizational-level were identified. Discussion: In the current literature, most studies pertain to the transition of older patients from hospital to home, there is a dearth in research elucidating the barriers related to intra- and inter-facility transfer of elderly patients. Of the barriers that we found, communication barriers were present in all three levels: individual, healthcare provider, and organizational. Limitations are presented. Conclusion: This review found several areas that should be improved for safer care transitions of elderly patients between facilities. The efficient and effective intra- and inter-establishment transfer of elderly patients in health care is impeded by a range of barriers, most importantly a lack of communication, which is found in every three levels of barriers. By categorizing the barriers to an efficient and effective transition of elderly patients into three levels: individual, health professional, and organizational, this scoping review hopes to present current research in a structured way for future research.