The Association Between Transfer Note Documentation and Appropriateness of Interhospital Transfer: A Pilot Study

Area of Science:

• Medical Informatics
• Healthcare Quality Improvement
• Patient Transfer Management

Background:

• Interhospital transfers (IHTs) are critical for patient care continuity.
• Standardized documentation aims to improve transfer appropriateness and outcomes.
• The impact of templated versus nontemplated IHT notes requires investigation.

Purpose of the Study:

• To evaluate the association between templated interhospital transfer (IHT) notes and transfer appropriateness.
• To assess the impact of documentation type on clinical outcomes following IHTs.

Main Methods:

• Retrospective single-center study of 100 IHTs to internal medicine services.
• Categorized documentation as templated note, nontemplated note, or no note.
• Assessed transfer appropriateness using a standardized framework; analyzed clinical outcomes for events >5% incidence.

Main Results:

• 81% of transfers were appropriate; 19% inappropriate.
• Transfers without documentation had the highest appropriateness rate (87.8%).
• Nontemplated notes in inappropriate transfers were associated with higher downgrade rates (50.0%).

Conclusions:

• Structured IHT documentation was inconsistently used and did not predict transfer appropriateness.
• Transfers without documentation were most often appropriate, suggesting simpler cases may not need formal notes.
• Unstructured documentation may inflate perceived patient acuity, necessitating further evaluation of documentation strategies.