Electronic Transfer Form Improves Patient Handoffs

August 2009

By Patrice Wendling
Elsevier Global Medical News

CHICAGO -- A standardized electronic form detailing essential patient information improved communication about transfers from a skilled nursing facility to an emergency department.

Physicians and staff used the electronic form for about half of 276 patient transfers from the nursing home to the Cleveland Clinic emergency department (ED) during an 8-month period, Dr. Fredric Hustey and geriatrician Dr. Robert Palmer reported at the annual meeting of the American Geriatrics Society.

On average, when the electronic form was used, eight of the nine information elements deemed essential were communicated, said Dr. Hustey, an emergency physician at the Cleveland Clinic.

The nine elements classified as essential were past medical history, medication use, allergies, advanced directives, reason for transfer, baseline mental status, baseline functional status, contact person at the nursing facility, and name of a primary care or other responsible physician. Only two of the essential elements had been transferred, on average, per patient before the electronic form was available.

The researchers said that use of the form significantly decreased paperwork from 24 pages of information transferred per patient to 5.5 pages. The original plan was to have the transfer form completed online, but once the researchers discovered the need to scan some records into the system because of their length, they opted to scan in all the information.

When the electronic form was not used, the ED received either no paperwork or used the old system of photocopying the patient's entire chart and sending it to the ED with the patient.

"Implementing an Internet-based system for communication between skilled nursing facilities and EDs is feasible and significantly improves communication and the efficiency of information transfer," he said.

ED staff satisfaction with the communication process increased 11% using the electronic form. Satisfaction with communications did not change among the nursing facility staff, possibly since training focused on nursing managers and unit secretaries because of high turnover of personnel during the study, including three medical directors.

The satisfaction survey also identified an adversarial relationship between the ED and skilled nursing facility personnel, which Dr. Hustey suggested is a common situation.

"I can't even repeat some of the quotes we got, but they were angry," he said. "One of the things we did was to foster meetings between the two environments to get people to understand what both sides are dealing with.

"I work in the ED and there's a great misconception as to what goes on in that skilled nursing facility. I've been over there several times and they have a very rough job and a very high acuity. And the same thing is true for the emergency department."

The research was supported by an AGS career-development grant in conjunction with the John A. Hartford Foundation and the Atlantic Philanthropies group. The authors reported no conflict of interest.


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