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Open Access Research article

Clinicians’ views on improving inter-organizational care transitions

Lianne Jeffs12*, Renee F Lyons34, Jane Merkley5 and Chaim M Bell67

Author Affiliations

1 Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Room 720, 30 Bond Street, Toronto, ON M5B 1W8, Canada

2 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada

3 Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Active Healthcare, 14 St. Matthews Road, Toronto, ON M4M 2B5, Canada

4 Dalla Lana School of Public Health and Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada

5 Executive Administration, Bridgepoint Active Healthcare, 14 St. Matthews Road, Toronto, ON M4M 2B5, Canada

6 Mount Sinai Hospital, 600 University Ave, Toronto, ON M5G 1X5, Canada

7 Department of Medicine and Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada

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BMC Health Services Research 2013, 13:289  doi:10.1186/1472-6963-13-289

Published: 30 July 2013

Abstract

Background

Patients with complex health conditions frequently require care from multiple providers and are particularly vulnerable to poorly executed transitions from one healthcare setting to another. Poorly executed care transitions can result in negative patient outcomes (e.g. medication errors, delays in treatment) and increased healthcare spending due to re-hospitalization or emergency room visits by patients. Little is known about care transitions from acute care to complex continuing care and rehabilitation settings. Thus, a qualitative study was undertaken to explore clinicians’ perceptions of strategies aimed at improving patient care transitions from acute care hospitals to complex continuing care and rehabilitation healthcare organizations.

Methods

A qualitative study using semi-structured interviews was conducted with clinicians employed at two selected healthcare facilities: an acute care hospital and a complex continuing care/rehabilitation organization, respectively. Analysis of the transcripts involved the creation of a coding schema using the content analyses outlined by Ryan and Bernard. In total, 31 interviews were conducted with clinicians at the participating study sites.

Results

Three themes emerged from the data to delineate what study participants described as strategies to ensure quality inter-organizational transitions of patients transferred from acute care to the complex continuing care and rehabilitation hospital. These themes are: 1) communicating more effectively; 2) being vigilant around the patients’ readiness for transfer and care needs; and 3) documenting more accurately and completely in the patient transfer record.

Conclusion

Our study provides insights from the perspectives of multiple clinicians that have important implications for health care leaders and clinicians in their efforts to enhance inter-organizational care transitions. Of particular importance is the need to have a collective and collaborative approach amongst clinicians during the inter-organizational care transition process. Study findings also suggest that the written patient transfer record needs to be augmented with a verbal report whereby the receiving clinician has an opportunity to discuss with a clinician from the acute care hospital the patient’s status on discharge and plan of care. Integral to future research efforts is designing and testing out interventions to optimize inter-organizational care transitions and feedback loops for complex medical patients.

Keywords:
Care transitions; Inter-organizational; Orthopedic patients