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Patient and physician experience with interhospital transfer: a qualitative study.

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Mueller SK, Shannon E, Dalal A, et al. J Patient Saf. 2021;17:e752-e757.

This single-site survey of resident and attending physicians across multiple specialties uncovered multiple safety vulnerabilities in the process of interhospital transfer. Investigators found that physicians and patients were both dissatisfied with timing of transfers and that critical patient records were missing upon transfer. These issues raise safety concerns for highly variable interhospital transfer practices.

In Conversation With… Jane Brice, MD, MPH

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May 1, 2019

Dr. Brice is Professor and Chair of the Department of Emergency Medicine at the University of North Carolina. She also serves as the Program Director for the Emergency Medical Services (EMS) Fellowship and was past-president of the National Association of EMS Physicians. We spoke with her about her experience working in emergency medical systems and safety concerns particular to this field.

Quantitative analysis of the content of EMS handoff of critically ill and injured patients to the emergency department.

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Goldberg SA, Porat A, Strother CG, et al. Prehosp Emerg Care. 2017;21:14-17.

Handoffs between prehospital emergency medical services (EMS) providers and hospital emergency departments (EDs) are known to be suboptimal. This record review of 90 EMS-to-ED handoffs at a single academic medical center found that essential information was often omitted. The authors suggest that further training is needed to enhance the quality of these handoffs.

Patient Safety.

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J Health Serv Res Policy. 2015;20(suppl 1):S1-S60.

Articles in this special supplement explore research commissioned by National Institute for Health Research in the United Kingdom to address four patient safety research gaps: how organizational culture and context influence evaluations of interventions, organizational boundaries that affect handovers and other aspects of care, the role of the patient in safety improvement, and the economic costs and benefits of safety interventions.

A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety.

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O'Hara R, Johnson M, Siriwardena N, et al. J Health Serv Res Policy. 2015;20:45-53.

This qualitative study explored decision-making by prehospital emergency providers and the effect these decisions can have on patient safety. The study identified both system-level and individual factors that influence critical decisions.

Clinical handovers between prehospital and hospital staff: literature review.

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Wood K, Crouch R, Rowland E, et al. Emerg Med J. 2015;32:577-581.

This review calls for research to understand challenges related to time, resources, and interprofessional relationships that affect information transfer between prehospital and hospital staff before implementing standard methods and tools for this type of handoff.

Analyzing communication errors in an air medical transport service.

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Dalto JD, Weir C, Thomas F. Air Med J. 2013;32:129-37.

Although interhospital air transport is generally safe, this analysis of quality assurance reports found that most errors involved communication problems.

Quality improvement and patient care checklists in intrahospital transfers involving pediatric surgery patients.

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Nakayama DK, Lester SS, Rich DR, et al. J Pediatr Surg. 2012;47:112-8.

This study demonstrated the impact of a checklist to reinforce communication and important points of care, while also providing important feedback on whether system goals were being met.

Patient safety in emergency medical services: a systematic review of the literature.

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Bigham BL, Buick JE, Brooks SC, et al. Prehosp Emerg Care. 2012;16:20-35.

This systematic review found that the literature base on patient safety issues in prehospital care is still quite small, limiting emergency medical services providers' ability to identify and address systematic problems in care.

A prospective review of adverse events during interhospital transfers of neonates by a dedicated neonatal transfer service.

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Lim MTC, Ratnavel N. Pediatr Crit Care Med. 2008;9:289-93.

This study discovered that avoidable human errors contribute to the majority of adverse events around interhospital transfers, and targeted prevention strategies should include further education and training efforts.

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