Development of a Tool to Measure Potentially Inappropriate Inter-Hospital Transfer (IHT): The POINT Study.

Area of Science:

• Healthcare quality improvement
• Patient safety research
• Health services research

Background:

• Inter-hospital transfer (IHT) aims to match patient needs with appropriate care but practices vary, risking care discontinuity.
• Identifying patients unlikely to benefit from IHT is crucial for preventing adverse outcomes and optimizing resource allocation.

Purpose of the Study:

• To define "potentially inappropriate IHT" through stakeholder consensus.
• To develop and validate a standardized adjudication process for identifying potentially inappropriate IHT.
• To lay the groundwork for evaluating the incidence and patient safety impact of these transfers.

Main Methods:

• Conducted stakeholder focus groups to establish a consensus definition of potentially inappropriate IHT.
• Developed an adjudication tool based on the consensus definition for retrospective chart review.
• Implemented rigorous adjudicator training to ensure process reliability and consistency.

Main Results:

• A consensus definition of potentially inappropriate IHT was established.
• A standardized adjudication tool and training protocol were developed and refined.
• The initial 2 years of the POINT Study focused on creating a reliable method for capturing potentially inappropriate IHT.

Conclusions:

• The developed adjudication process is ready for broader implementation across 18 hospital sites.
• Future work will involve adjudicating 1800 transfer cases to understand the prevalence and risk factors of potentially inappropriate IHT.
• This research will provide foundational data on the patient safety implications of inappropriate inter-hospital transfers.