Hospital Transfers: 5 Best Practices for Facilities
As patient acuity rises and clinical demands become more complex, individuals are likely to require care from specialized facilities. While many acute-care hospitals provide comprehensive emergency services, they might not offer the surgeries, treatments, or support services required to stabilize patients after immediate resuscitation.
Hospital transfers allow patients to get the care they need from a facility capable of providing the necessary interventions. As patient transfers become more common, it’s important that administrators streamline their facility’s practices to prevent the negative consequences associated with fragmented care.
In this article, we introduce the importance of efficient patient transfers, explain the risks associated with poorly executed transfers, and list tips for facility leaders looking to streamline their patient transfer practices to optimize care safety and quality.
What Are Hospital Transfers?
A hospital transfer refers to the movement of a patient from one care setting to another. Sometimes, patient transfers occur between different departments of the same facility. Alternatively, patients may be transported from one healthcare facility to another.
What Are the Different Types of Patient Transfers?
There are three main types of patient transfers: primary, inter-hospital, and intra-hospital transfers. We provide an explanation of each in the table below.
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| Primary Transfer | This type of patient transfer involves the transport of a patient from the scene of their illness or injury to an appropriate care facility. This is usually carried out via ground (ambulance) or air (helicopter or airplane) medical transport.
Example: A patient is involved in a motor vehicle accident on the highway and is transferred to a local emergency department by helicopter. |
| Inter-Hospital Transfer | These transfers involve the movement of a patient from one medical facility to another. Patients are usually transported by a medical transport team.
Example: A patient is transported from an orthopedic surgical center to an outpatient rehab facility by ambulance. |
| Intra-Hospital Transfer | These transfers are less complicated and involve the transport of a patient from one unit to another unit within the same hospital. Patients can be moved in a stretcher, hospital bed, wheelchair, or on foot, depending on the patient’s health status and mobility level.
Example: A patient is moved from the ICU to the cardiac step down unit by wheelchair. |
What Are the Most Common Reasons for Hospital Transfers?
Patients are transferred between facilities or units for a variety of reasons, including:
Specialized Testing, Treatment, or Surgery
The goal of most primary and intra-hospital transfers is to get the patient to a facility that performs the level of care they need as quickly as possible. For example, let’s consider a patient who experiences kidney failure while receiving care at a rehabilitation facility. They would require transfer to a local acute-care hospital or dialysis facility with the equipment and staff necessary to administer the dialysis procedure.
Change in a Patient’s Acuity
Transfers can be made to upgrade or downgrade the complexity of care. For example, a patient recovering after heart surgery may no longer require the 24-hour support of the ICU. Once stable, they’d move to a basic cardiac unit for the final days of their recovery. A patient who acquires a serious infection on a standard orthopedic unit, however, may need to be transferred to the ICU for IV antibiotic treatment.
Patient Request
Why can a patient request a transfer to another hospital? CMS mandates that patient-requested transfers be granted so long as the desired hospital has the capacity and capability to provide the necessary care. Individuals may want to move facilities for a number of reasons, whether they prefer staying in a hospital closer to their loved ones or they’re unsatisfied with the standard of care at their current facility.
What Are the Risks of Poor or Delayed Hospital Transfer?
Sometimes, patient transfers don’t go as planned. Operations may be held up due to staffing or bed shortages. In other circumstances, patient transfer could be delayed for hours while administrators and family members scramble to complete the necessary insurance forms. When transfer issues arise:
- Patients are placed at increased risk for health complications and death.
- There is greater dissatisfaction among patients, family members, and clinicians.
- Healthcare spending costs increase, impacting patients, insurance providers, and facilities.
Improving Your Patient Transfer Practices: 5 Tips
Now that you understand the importance of safe patient transfers, you might be looking for tips to optimize your organization’s transfer practices. Here are five strategies to get the ball rolling.
1. Establish Shared Governance Councils to Identify Hospital Transfer Concerns
Whether you’re developing a new patient transfer policy or looking for insights on how to improve current practices, shared governance councils can help your organization identify and remove barriers to efficient patient transfer. By establishing multidisciplinary teams of bedside clinicians, transfer center staff, and facility administrators, you can encourage your staff to explore solutions to transfer problems they experience on the job.
Healthcare staff members appreciate being a part of quality improvement efforts and are excited to make positive changes in their place of work. By involving your staff in the redesign of care processes, you can boost employee engagement and retention while also optimizing patient safety and satisfaction.
Example:
Encourage your shared governance councils to investigate:
- Transfer delays and the causes of these setbacks.
- Safety events that occurred during transfer and how to prevent future complications.
- Complaints made by patients and their family members regarding the transfer process.
2. Incorporate CMS Guidelines for Hospital Transfers Into Your Care Practices
The Centers for Medicare and Medicaid Services (CMS) has established patient transfer guidelines that must be followed by Medicare-certified hospitals. Be sure to incorporate these rules into your unique transfer policy to ensure that your facility is reimbursed appropriately for the patient care you provide.
Example:
The Emergency Medicine Treatment and Active Labor Act (EMTALA) applies to hospitals that accept CMS and HHS payments. According to EMTALA law, “it is the physician at the sending hospital that is primarily responsible for the determination of patient stability and clinical appropriateness for a transfer.”
When designing your patient transfer policies, ensure that your documentation guidelines specify that the “sending” physician must document patient stability in the EMR prior to initiating a transfer request. Informing your team of their clinical accountability can ensure regulatory compliance and streamline the transfer process.
3. Provide Staff Training On Safe Patient Transfer Guidelines
Once you’ve developed facility-specific patient transfer guidelines, you’ll want to ensure your staff are able to execute these transfers effectively. By familiarizing your team with your unique policies and procedures, they’ll feel empowered with the knowledge and skills necessary to keep patients safe.
Example:
- Provide a hospital transfer training course during new hire onboarding and orientation.
- Post applicable resources to your organization’s website, in the employee handbook, and on hospital bulletin boards.
- Create a patient transfer policy and procedure manual and distribute it to all clinicians.
4. Involve Patients and Families in the Hospital Transfer Process
Poorly planned and executed transfers leave many patients and family members feeling out of the loop. This can contribute to worry and anxiety for the steps ahead.
Once a hospital transfer has been initiated, it’s important to encourage patients to take an active role in the transfer process. Showing them that you value their input and perspective builds trust and loyalty between care facilities and the individuals they serve.
Example:
Enhance patient and family involvement by:
- Allowing choice when possible.
- Notifying all parties as soon as the transfer has been initiated.
- Keep informed about any updates, changes, or delays at all stages of the transfer process.
5. Solicit Feedback From Key Stakeholders
Patients and their family members may have strong opinions about their hospital transfer. Encouraging individuals to share details about what made their transfer a positive or negative experience can help your team improve practices in the future.
Example:
Request feedback by:
- Distributing transfer satisfaction surveys to patients and their family members.
- Asking staff members about recent transfers during a safety huddle.
- Hosting collaborative town hall meetings with other local facilities to discuss concerns.
Discover More Ways to Improve Patient Safety
Knowing how to execute safe hospital transfers is one way to enhance safety and care quality at your organization. Looking to optimize other care practices? Follow along in our free healthcare newsletter for additional tips, resources, and guides to help your team thrive.