title: Information handoff and outcomes of critically ill patients transferred between hospitals.
abstract: Patients transferred between hospitals are at high risk of adverse events and mortality. This study aims to identify which components of the transfer handoff process are important predictors of adverse events and mortality.
  
  
  
  We conducted a retrospective, observational study of 335 consecutive patient transfers to 3 intensive care units at an academic tertiary referral center. We assessed the relationship between handoff documentation completeness and patient outcomes. The primary outcome was in-hospital mortality. Secondary outcomes included adverse events, duplication of labor, disposition error, and length of stay.
  
  
  
  Transfer documentation was frequently absent with overall completeness of 58.3%. Adverse events occurred in 42% of patients within 24 hours of arrival, with an overall in-hospital mortality of 17.3%. Higher documentation completeness was associated with reduced in-hospital mortality (odds ratio [OR], 0.07; 95% confidence interval [CI], 0.02 to 0.38; P = .002), reduced adverse events (coefficient, -2.08; 95% CI, -2.76 to -1.390; P < .001), and reduced duplication of labor (OR, 0.19; 95% CI, 0.04 to 0.88; P = .033) when controlling for severity of illness.
  
  
  
  Documentation completeness is associated with improved outcomes and resource utilization in patients transferred between hospitals.
authors: Department of Medicine, Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, MN 55455. Electronic address: mgusher@umn.edu.
authors: Michael G
authors: MG
authors: Usher
authors: Department of Medicine, Division of General Internal Medicine, Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ 08901.
authors: Christine
authors: C
authors: Fanning
authors: Department of Medicine, Division of General Internal Medicine, Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ 08901.
authors: Di
authors: D
authors: Wu
authors: Department of Medicine, Division of General Internal Medicine, Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ 08901.
authors: Christine
authors: C
authors: Muglia
authors: Department of Medicine, Division of General Internal Medicine, Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ 08901.
authors: Karen
authors: K
authors: Balonze
authors: Department of Medicine, Division of Pulmonary and Critical Care, Boston University School of Medicine, Boston, MA 02118.
authors: Deborah
authors: D
authors: Kim
authors: Department of Medicine, Divisions of Nephrology and Critical Care, Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ 08901.
authors: Amay
authors: A
authors: Parikh
authors: Department of Medicine, Division of General Internal Medicine, Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ 08901.
authors: Dana
authors: D
authors: Herrigel
mesh_terms: D000368:Aged; D016638:Critical Illness / Q000401:mortality*; D004282:Documentation / Q000592:standards*; D005260:Female; D006295:Health Resources; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062209:Patient Handoff / Q000592:standards*; D010360:Patient Transfer; D010865:Pilot Projects; D012189:Retrospective Studies; D062606:Tertiary Care Centers
keywords: Handoff; ICU mortality; Information; Interhospital transfer; Transitions of care