Interhospital transfers from the emergency department: a mixed-methods study on their characteristics and contextual...

Despite an increase in interhospital transfers and the safety risks they represent for patients, little is known about the quality of clinical practices in this field. This study aimed to characterize interhospital transfers by ambulance from the Emergency Departments (ED) of a university hospital and clinicians' perceptions on barriers and facilitators to quality interhospital transfers.

This single-center, prospective descriptive study used a convergent mixed-methods design and was conducted in two phases between May and December 2023. The study was informed by the Donabedian Model for quality improvement and its structure, process and outcomes domains. Quantitative data were collected from the medical records of transferred ED patients and qualitative data from semi-structured interviews with multidisciplinary clinicians involved in interhospital transfers. Descriptive statistics (quantitative) and content analysis (qualitative) were conducted.

Characteristics: a total of 72 interhospital transfers were evaluated, with 86.1% carried out for specialized treatment. A nurse accompanied 68.1% of the transfers and respiratory and intravenous equipment was used in about 40% of them. Mean total transfer time was 64.8 (± 20.4) minutes and medication adjustments were performed in 20% of transports supervised by nurses. Among the 57 transfers with complete data, 37 (64.9%) adverse events were observed; 49.1% clinical, 12.3% logistical and 3.5% technical. The 11 interviewed clinicians identified several barriers impacting the quality of interhospital transfers including: equipment issues, insufficient organizational resources, insufficiently prepared patients, and the overall complexity of the transfer process. To address these challenges, they proposed developing specialized expertise, enhancing standardization, establishing multidisciplinary transfer teams dedicated to transfers and integrating paramedics more effectively into the process.

This study characterized ED interhospital transfers and the key barriers and facilitators to quality care as perceived by clinicians. Logistical and organizational challenges were highlighted. These findings can inform future quality improvement initiatives targeting interhospital transfer practices.