Implementation of Mandatory Inter-Facility Communication in Oregon: Insights from Year One

BACKGROUND:  In January 2014, Oregon instituted a mandatory inter-facility transfer law (Oregon Administrative Rule 333-019-0052) called “Communication During Patient Transfer of Multidrug-Resistant Organisms (MDRO)” and Clostridium difficile infection (CDI) for acute, ambulatory, and residential healthcare facilities. The law mandates written communication of a patient’s MDRO or CDI status to the receiving facility. We sought to: 1) evaluate reported compliance with the law, confidence in notification to and by partner facilities, and mechanisms for identifying patients requiring Transmission-based Precautions prior to admission; and 2) assess differences in these metrics for hospitals versus skilled nursing facilities (SNFs) in Oregon.

METHODS:  In January 2015, we surveyed 60 hospital infection preventionists and 142 SNF directors of nursing in Oregon (97% and 100% response rate, respectively). We examined differences between hospitals and SNFs using chi-square tests. In addition, we assessed differences in a small subset of responses from the 2015 hospital survey that were comparable to questions asked on the 2012 survey.

RESULTS:  Reported compliance with Oregon’s inter-facility transfer rule in 2014 did not vary significantly by facility type (83% for hospitals and 73% for SNFs). For both hospitals and SNFs, 92% of facilities “agreed” or “strongly agreed” that their facilities notified receiving facilities of a patient’s MDRO or CDI status upon discharge. Conversely, 38% of hospitals and 53% of SNFs “agreed” or “strongly agreed” that other facilities adequately notified them of a patient’s MDRO or CDI status upon transfer (p=0.06). Hospitals and SNFs varied in their use of separate inter-facility transfer forms to identify patients with MDROs upon admission (48% vs. 24%, respectively, p<0.01) as opposed to other forms of documentation. Fewer hospitals than SNFs reviewed patient records prior to admission to identify patients with MDROs (12% vs 82%, p<0.001). The percentage of IPs that reported using inter-facility transfer communication forms doubled from 24% to 48% (p<0.001) between 2012 to 2015 hospital surveys.

CONCLUSIONS:  The majority of Oregon’s hospitals and SNFs reported compliance with the inter-facility transfer communication law. Most felt confident that they notified partner facilities of a patient’s MDRO or CDI status upon transfer, but reported lower levels of confidence in other facilities’ notification practices. Hospitals and SNFs reported differences in how they use inter-facility transfer forms. State health departments should look for opportunities to convene key personnel from clusters of hospitals and SNFs that frequently transfer patients to optimize documentation methods and build trust related to communication of Transmission-based Precaution requirements.