Intrahospital transfers and adverse patient outcomes: An analysis of administrative health data.

AIMS AND OBJECTIVES

To determine whether there was an association between intra-hospital transfers and adverse outcomes.

BACKGROUND

Transfers between clinical units and between beds on the same unit are routine aspects of an episode of care in acute hospitals. The rate of these transfers per episode has increased in response to high occupancy levels, a decline in bed numbers, and increased demand for hospital services. The impact of the number of transfers between both wards and beds on patient outcomes is not widely explored.

DESIGN

Retrospective cross sectional design using hospital administrative data.

METHOD

Data were extracted from existing hospital administrative datasets for one large metropolitan hospital for the financial year 2008-09 in Australia (n = 14,133). Descriptive analyses and logistic regression models were developed for each of 3 selected patient outcomes.

RESULTS

Nearly one-tenth of patients (9.2%) experienced a fall with injury, 3.8% of surgical patients a wound infection and 0.1% a complication from medication errors. For each bed or ward transfer, the odds of falls and wound infections increased. Medication errors were not associated with either bed or ward moves.

CONCLUSION

Hospitals should minimise the number of bed and ward transfers per episode of care in order to reduce the likelihood of adverse patient outcomes. Current bed management policies and practices should be evaluated and further refined to address this need. Additional strategies include improving coordination and communication during and after transfer.

RELEVANCE TO CLINICAL PRACTICE

Nurses must consider the potential cost of intrahospital transfers on patients, length of stay and bed availability.