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Open Access Study protocol

The Seamless Transfer-of-Care Protocol: a randomized controlled trial assessing the efficacy of an electronic transfer-of-care communication tool

Barbara M Okoniewska1*, Maria J Santana1*, Jayna Holroyd-Leduc23, Ward Flemons4, Maeve O’Beirne5, Deborah White6, Fiona Clement23, Alan Forster7 and William A Ghali1

Author Affiliations

1 Department of Community Health Sciences, W21C Research and Innovation Centre, Institute of Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada

2 Department of Community Health Sciences, Faculty of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada

3 Department of Medicine, Faculty of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada

4 Department of Medicine, Faculty of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada

5 Department of Family Medicine, Faculty of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada

6 Faculty of Nursing, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, Canada

7 Department of Medicine, University of Ottawa, Ottawa, Canada

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BMC Health Services Research 2012, 12:414  doi:10.1186/1472-6963-12-414

Published: 21 November 2012

Abstract

Background

The transition between acute care and community care represents a vulnerable period in health care delivery. The vulnerability of this period has been attributed to changes to patients’ medication regimens during hospitalization, failure to reconcile discrepancies between admission and discharge and the burdening of patients/families to take over care responsibilities at discharge and to relay important information to the primary care physician. Electronic communication platforms can provide an immediate link between acute care and community care physicians (and other community providers), designed to ensure consistent information transfer. This study examines whether a transfer-of-care (TOC) communication tool is efficacious and cost-effective for reducing hospital readmission, adverse events and adverse drug events as well as reducing death.

Methods

A randomized controlled trial conducted on the Medical Teaching Unit of a Canadian tertiary care centre will evaluate the efficacy and cost-effectiveness of a TOC communication tool. Medical in-patients admitted to the unit will be considered for this study. Data will be collected upon admission, and a total of 1400 patients will be randomized. The control group’s acute care stay will be summarized using a traditional dictated summary, while the intervention group will have a summary generated using the TOC communication tool. The primary outcome will be a composite, at 3 months, of death or readmission to any Alberta acute-care hospital. Secondary outcomes will be the occurrence of post-discharge adverse events and adverse drug events at 1 month post discharge. Patients with adverse outcomes will have their cases reviewed by two Royal College certified internists or College-certified family physicians, blinded to patients’ group assignments, to determine the type, severity, preventability and ameliorability of all detected adverse outcomes. An accompanying economic evaluation will assess the cost per life saved, cost per readmission avoided and cost per QALY gained with the TOC communication tool compared to traditional dictation summaries.

Discussion

This paper outlines the study protocol for a randomized controlled trial evaluating an electronic transfer-of-care communication tool, with sufficient statistical power to assess the impact of the tool on the significant outcomes of post-discharge death or readmission. The study findings will inform health systems around the world on the potential benefits of such tools, and the value for money associated with their widespread implementation.

Trial registration

ClinicalTrials.gov NCT01402609.

Keywords:
Medical informatics, Care transitions, Electronic health records; Randomized controlled trials; Hospital discharge