Impact of an intervention to control risk associated with patient transfer.
OBJECTIVE
Hospitals transferring patients retain responsibility until admission to the new health care facility. We define safe transfer conditions, based on appropriate risk assessment, and evaluate the impact of this strategy as implemented at our institution.


METHODS
An algorithm defining transfer categories according to destination, equipment monitoring, and medication was developed and tested prospectively over 6 months. Conformity with algorithm criteria was assessed for every transfer and transfer category. After introduction of a transfer coordination centre with transfer nurses, the algorithm was implemented and the same survey was carried out over 1 year.


RESULTS
Over the whole study period, the number of transfers increased by 40%, chiefly by ambulance from the emergency department to other hospitals and private clinics. Transfers to rehabilitation centres and nursing homes were reassigned to conventional vehicles. The percentage of patients requiring equipment during transfer, such as an intravenous line, decreased from 34% to 15%, while oxygen or i.v. drug requirement remained stable. The percentage of transfers considered below theoretical safety decreased from 6% to 4%, while 20% of transfers were considered safer than necessary. A substantial number of planned transfers could be "downgraded" by mutual agreement to a lower degree of supervision, and the system was stable on a short-term basis.


CONCLUSIONS
A coordinated transfer system based on an algorithm determining transfer categories, developed on the basis of simple but valid medical and nursing criteria, reduced unnecessary ambulance transfers and treatment during transfer, and increased adequate supervision.
Wasserfallen
Jean-Blaise
JB
Medical Direction, University Hospital, Lausanne, Switzerland. jbw@chuv.ch
Meylan
Nicolas
N
Schaller
Marie-Denise
MD
Chioléro
René
R
Fishman
Daniel
D
D000465:Algorithms; D006801:Humans; D009738:Nursing Service, Hospital; D010360:Patient Transfer / Q000379:methods*; D015397:Program Evaluation; D011446:Prospective Studies; D018570:Risk Assessment; D012308:Risk Management; D017751:Safety Management