ENHANCED COMMUNICATION TO FRONTLINE PROVIDERS RECEIVING INTERHOSPITAL TRANSFERS INCREASES THEIR PREPAREDNESS: A QUALITY IMPROVEMENT INITIATIVE FROM AN ACADEMIC TRANSPLANT CENTER

ABSTRACT

Background: Our high-volume, academic liver transplant center accepts many interhospital transplant evaluation referrals to inpatient teams with resident frontline providers (RFLPs). Though standardized communication occurs between sending hospitals and accepting fel-lows/attendings, no such process exists for residents, who are first to evaluate these patients and triage them to teams for care to begin. Most patients arrive at night, when fellows/ attendings are offsite. Our quality improvement project sought to improve clinical information sharing for interhospital transfers such that housestaff were aware of 100% of incoming transfers and had access to their clinical summaries. Interventions: Two QI committee-approved, HIPAA-compliant communication initiatives were launched. In 2/2020, an email notification system to triage residents shared planned arrival time for patients pending transfer. In 7/2020, a clinical data repository (“Transfer Log”) where fellows documented updated clinical notes and management recommendations was made available to RFLPs for use overnight. Measures: Qualitative and quantitative data were assessed at different timepoints. Likert scale surveys assessing resident comfort with the transfer process were administered before 2/2020 email intervention (pre) and after 7/2020 transfer log intervention (post). Time from patient arrival to team assignment (TTA) in the electronic health record was used as a proxy for time to patient assessment by a resident;this was measured before and after each intervention separately (email/transfer log). Patients arriving during the first COVID-19 surge were excluded because redeployment altered team/triage structures. Results: Intervention emails were delivered for 159/176 patients. Housestaff respondents reported frequency of access to clinical information as follows pre-interventions 4/31 some-times/very often;27/31 never/rarely. Post-interventions 11/26 sometimes/very often;15/26 never/rarely (Fisher's exact p=0.02). Pre-interventions 12/39 felt “not at all prepared” vs. 27/39 somewhat/adequately prepared;post-interventions 2/24 felt “not at all prepared” vs. 22/24 somewhat/adequately (Fisher's exact p=0.06). For TTA, there were 178 “pre-email” and 176 “post-email” patients. There were 259 “pre-transfer log” (including 178 “pre-email”) and 95 “post-transfer log” patients. There was no significant difference in mean TTA pre-vs. post-email (p=0.86) (Fig 1). There was a significant difference in mean TTA pre- vs. post-transfer log (55 minutes pre vs. 40 post, p=0.02);variance was smaller in the posttransfer log group (33 vs. 58, F statistic 3.06, p<0.01) (Fig 2). Early notification and increased access to clinical information for RFLPs were associated with better sense of preparedness for admitting housestaff;access to clinical information may account for this positive change. $Φgure