Organisational factors underpinning intra-hospital transfers: a guide for evaluating context in quality improvement. Issue 4 (2nd October 2021)

• Record Type: Journal Article
• Authors: Fekieta, Renee; Rosenberg, Alana; Hodshon, Beth; Feder, Shelli; Chaudhry, Sarwat I.; Emerson, Beth L.
• Is Part Of: Health systems. Volume 10:Issue 4(2021)
• Page Start: 239
• Page End: 248
• Publication Date: 2021-10-02
• Subjects: Patient transitions -- quality improvement -- context -- qualitative analysis; 610.285
• DOI: 10.1080/20476965.2020.1768807
• Languages: English
• ISSNs: 2047-6965

Abstract

ABSTRACT: During intra-hospital transfers, multiple clinicians perform coordinated tasks that leave patients vulnerable to undesirable outcomes. Communication has been established as a challenge to care transitions, but less is known about the organisational complexities within which transfers take place. We performed a qualitative assessment that included various professions to capture a multi-faceted understanding of intra-hospital transfers. Ethnographic observations and semi-structured interviews were conducted with clinicians and staff from the Medical Intensive Care Unit, Emergency Department, and general medicine units at a large, urban, academic, tertiary medical centre. Results highlight the organisational factors that stakeholders view as important for successful transfers: the development, dissemination, and application of protocols; robustness of technology; degree of teamwork; hospital capacity; and the ways in which competing hospital priorities are managed. These factors broaden our understanding of the organisational context of intra-hospital transfers and informed the development of a practical guide that can be used prior to embarking on quality improvement efforts around transitions of care.