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J Stroke Cerebrovasc Dis ; 28(6): 1759-1766, 2019 Jun.
Article in English | MEDLINE | ID: mdl-30879712

ABSTRACT

GOAL: Interhospital transfer (IHT) facilitates access to specialized neurocritical care but may also introduce unique risk. Our goal was to describe providers' perceptions of safety threats during IHT for patients with nontraumatic intracranial hemorrhage. MATERIALS AND METHODS: We employed qualitative, semi-structured interviews at an academic medical center receiving critically-ill neurologic transfers, and 5 referring hospitals. Interviewees included physicians, nurses, and allied health professionals with experience caring for patients transferred between hospitals for nontraumatic intracranial hemorrhage. Interviews continued until data saturation was reached. Coding occurred concurrently with interviews. Analysis was inductive, using the constant comparative method. FINDINGS: The predominant impediments to safe, high-quality neurocritical care transitions between hospitals are insufficient communication, gaps in clinical practice, and lack of IHT structure. Insufficient communication highlights the unique communication challenges specific to IHT, which overlay and compound known intrahospital communication barriers. Gaps in clinical practice revolve primarily around the provision of neurocritical care for this patient population, often subject to resource availability, by receiving hospital emergency medicine providers. Lack of structure outlines providers' questions that emerge when institutions fail to identify process channels, expectations, and accountability during complex neurocritical care transitions. CONCLUSIONS: The predominant impediments to safe, high-quality neurocritical care transitions between hospitals are insufficient communication, gaps in clinical practice, and lack of IHT structure. These themes serve as fundamental targets for quality improvement initiatives. To our knowledge, this is the first description of challenges to quality and safety in high-risk neurocritical care transitions through clinicians' voices.


Subject(s)
Delivery of Health Care, Integrated/organization & administration , Intracranial Hemorrhages/therapy , Patient Safety , Patient Transfer/organization & administration , Attitude of Health Personnel , Cooperative Behavior , Health Knowledge, Attitudes, Practice , Humans , Interdisciplinary Communication , Interviews as Topic , Intracranial Hemorrhages/diagnosis , Patient Care Team/organization & administration , Professional Practice Gaps , Prognosis , Qualitative Research , Risk Assessment , Risk Factors , Time Factors
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