Deciphering the Details of Inter-Facility Patient Transfers in Washington, District of Columbia

BACKGROUND: The emergence and spread of multi-drug resistant organisms (MDROs) is a serious public health threat. Healthcare-associated infections (HAIs) caused by these bacteria result in significant morbidity and mortality, and add considerable costs to the healthcare system due to prolonged and costlier treatments. To prevent the spread of MDROs, inter-facility communication and a coordinated regional approach are recommended. Patients at increased risk of MDRO infection are often chronically ill, and receive care in multiple healthcare facilities (HCFs), thus serving as mobile reservoirs for the transmission of these bacteria to other patients. Patient transfers represent an important point of intervention, and the complex interactions within and between HCFs during this process that enable MDROs to spread must be better understood in order to develop effective interventions. The District of Columbia (DC) Department of Health (DOH) formed an HAI Advisory Committee (DCHAC) in 2016 to bring together stakeholders from acute and long-term healthcare settings to address this and other HAI prevention issues.

METHODS: DCHAC developed a survey consisting of quantitative and qualitative questions to understand patient transfer practices utilized by each facility and facility type (e.g. skilled nursing facility [SNF], acute care hospital [ACH]), as well as the impact of transferring facilities’ practices. The ten ACHs and 18 SNFs in DC were asked to complete the paper survey and email responses to the DOH. Qualitative data were analyzed thematically in a multi-step process using the constant comparative method that is central to grounded theory.¹

RESULTS: All ten ACHs and eight SNFs completed the survey. Processes, personnel involved, infrastructure, and capacity varied widely by HCF. Transferring and receiving facilities often reported contradictory information. Major challenges reported by HCFs when transferring patients included the administrative and medical capacity of the receiving facility, insurance authorization, timely and adequate transportation, and continuation of care. When receiving patients, the primary challenge cited was poor or inaccurate communication of clinical information by the transferring HCF, as well as by appropriate staff within the receiving facility.

CONCLUSIONS: There is a lack of communication and objective understanding among HCFs about the practices and challenges encountered by other facilities in the patient transfer process. Previous dialogue and prevention efforts were often misinformed due to preconceived assumptions about other facilities’ practices. These survey data provided valid information for discussion and prompted productive conversation leading to identification of proposed interventions, reinforcing the need for regional collaboration and properly informed inter-facility communication to prevent the spread of MDROs.