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Collaboration between a referring hospital and a tertiary care center in improving the transfer process for cardiac
C A Sivaram1, D Jarolim, A Nasser
1Section of Cardiology, Department of Veterans Affairs Medical Center, Oklahoma City 73104-5018, USA.
Insights
Improving cardiac patient transfers between hospitals significantly reduced wait times and enhanced physician satisfaction. This quality improvement project streamlined the process for specialized cardiac care, benefiting patient outcomes.
Area of Science:
- Cardiology
- Healthcare Quality Improvement
- Hospital Administration
Background:
- Hospital transfers for cardiac patients requiring specialized procedures are complex.
- The Department of Veterans Affairs Medical Center (DVAMC) in Muskogee transferred cardiac patients to DVAMC in Oklahoma City.
- Inefficiencies in the transfer process prompted a quality improvement initiative.
Purpose of the Study:
- To enhance the efficiency and quality of inter-hospital transfers for cardiac patients.
- To address concerns regarding the existing transfer process for specialized cardiac care.
Main Methods:
- Shifted focus from administrative to medical aspects of patient transfer.
- Improved direct physician access between referring and accepting hospitals.
- Implemented a quality improvement project starting in late 1992.
Main Results:
- Decreased transfer time: from 33% within 24 hours pre-project to 78-89% post-project.
- Significant improvement in physician satisfaction with services at the accepting facility.
- Successful implementation of enhanced communication and transfer protocols.
Conclusions:
- Enhanced collaboration expanded the continuum of care between hospitals.
- Transfer priority could be adjusted safely without increasing resource use.
- The quality improvement project demonstrated a more efficient and effective transfer system for cardiac patients.
Background:
Transfer of cardiac patients between hospitals is a complex process with many implications for quality of care. In the case of heart disease, specialized procedures such as coronary angioplasty, coronary bypass surgery, and valve replacement or repair require the performance of cardiac catheterization and coronary arteriography in a catheterization laboratory, as well as the availability of cardiac surgical services. The Department of Veterans Affairs Medical Center (DVAMC) at Muskogee, Oklahoma, transfers most cardiac patients requiring specialized diagnostic procedures and advanced cardiac care to DVAMC at Oklahoma City, Oklahoma. Concerns about the inefficiency of the transfer process led to the launch of a quality improvement project in late 1992. CHANGES IN THE TRANSFER PROCESS: Greater emphasis was placed on medical aspects compared to administrative aspects of transfer, and ready access to the physicians at DVAMC at Oklahoma City was provided.
Results:
The time from request for transfer to the actual transfer decreased. Before the quality improvement project, only 33% of transfers of cardiac patients were completed within 24 hours-versus 78% in 1993 and 1994, 89% in 1995, and 84% in the first half of 1996. In addition, DVAMC-Muskogee physician satisfaction regarding services at DVAMC-Oklahoma City improved.
Conclusion:
Ongoing discussion between the cardiology team at the accepting hospital and physicians at the referring hospital expanded the continuum of care to both hospitals. Priority of transfers could be upgraded at any time without unduly jeopardizing patient safety or increasing resource utilization at the receiving center.