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NCT Number: NCT05876429

Optimizing the Safety of Inter-Hospital Transfer

This proposal aims to design, implement and rigorously evaluate a standardized accept note in a population of patients that have high frequency of IHT, including patients transferred to the general medical (GMS), cardiology and oncology services at a large tertiary care hospital. This study will improve scientific knowledge by quantifying the patient safety impact of an intervention to improve communication of essential clinical information during IHT. If shown effective, the results of this study can be used to improve clinical practice by establishing evidence-based communication guidelines for broad dissemination. We will also establish technical feasibility by successfully implementing this tool within our EHR (Epic, Verona, WI), allowing for feasible adoption and dissemination to other institutions with similar EHR capabilities. Lastly, we will address malpractice risk by investigating a strategic intervention aimed at reducing known contributors to patient harm during IHT, a high-risk transition in care that involves transfer of high-acuity patients between providers, settings and systems of care.

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Key information

Conditions

Inpatient Facililty Diagnoses

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Brigham & Women's Hospital

Boston, Massachusetts, 02115, United States

About this study

Inter-hospital transfer (IHT), commonly performed to provide patients with more specialized care, involves transfer of patients between providers, settings and systems of care, leaving these patients vulnerable to the risks of discontinuity of care. Standardized communication tools, which have been successful at reducing patient harm among other similar hospital-based care transitions (i.e., intra-hospital patient handoffs), have been under-utilized during IHT to-date, leaving the process largely non-standardized and variable.

The overall goal of this proposal is to optimize patient safety during IHT to GMS, cardiology and oncology services, collectively comprising nearly 50% of all IHT to Brigham and Women's Hospital (BWH), by leveraging our pilot work to design, implement and rigorously evaluate a standardized communication tool to be used during IHT. We propose the following Specific Aims to accomplish this goal:

Aim 1. Utilize pilot data and stakeholder input to revise the standardized accept note.

Aim 2a. Implement the revised standardized accept note for all patients transferred from another acute care hospital to the GMS, cardiology, and oncology inpatient services at BWH.

Aim 2b. Shift the responsibility of documentation of the accept note from a diffuse group of individual clinicians to a small group of dedicated nurses within the Access Center.

Aim 3. Prospectively evaluate the impact of the intervention on patient safety outcomes, including: clinician-reported medical errors and adverse events, length of stay after transfer, rapid-response or code within 6-hours of transfer, ICU-transfer within 24-hours of transfer, and 3-day and in-hospital mortality.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • source of admission is inpatient transfer from another acute care hospital
  • admitted to general medical service
  • admitted to cardiology service
  • admitted to oncology service
  • admitted to ICU service
  • age >= 18

Exclusion criteria

  • source of admission is other than inpatient transfer
  • admitted to service other than listed above
  • age < 18

Treatment and study plan

New Standardized Accept Note

Other

A standardized accept note for transfer patients will be implemented, after stakeholder engagement and subsequent finalization.

Existing Transfer Patient Admission Process

Other

Maintain existing transfer patient admission processes, across GMS, Cardiology, and Oncology services.

Primary outcomes

  1. clinician-reported medical errors and adverse events

    Time frame: Up to 2 weeks

    Medical errors and adverse events measured as the total number of medical errors per patient

Secondary outcomes

  1. Presence of any adverse event after transfer

    Time frame: up to 2 weeks

    Clinician reported adverse events for each transferred patient

  2. Preventable adverse event after transfer

    Time frame: up to 2 weeks

  3. Ameliorable adverse event after transfer

    Time frame: up to 2 weeks

  4. Length of stay of hospitalization after transfer

    Time frame: up to 2 weeks

  5. ICU-transfer within 24 hours of transfer

    Time frame: Up to 24 hours

  6. In-hospital mortality

    Time frame: up to 30 weeks

  7. presence of accept note

    Time frame: Up to 24 hours

  8. timeliness of accept note

    Time frame: Up to 24 hours

Sponsors and collaborators

Lead sponsor

Brigham and Women's Hospital

Other

Collaborators

  • Crico

Registry information

Important dates

Study start
2020
Primary completion
2022
Study completion
2023
First posted
May 25, 2023
Registry last updated
Jan 23, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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