Department of Medicine, Mount Sinai Hospital, New York, New York, United States.
Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital, New York, New York, United States.
Appl Clin Inform. 2022 Aug;13(4):811-819. doi: 10.1055/s-0042-1756371. Epub 2022 Aug 31.
This quality improvement project sought to enhance clinical information sharing for interhospital transfers to an inpatient hepatology service comprised of internal medicine resident frontline providers (housestaff) with the specific aims of making housestaff aware of 100% of incoming transfers and providing timely access to clinical summaries.
In February 2020, an email notification system to senior medicine residents responsible for patient triage shared planned arrival time for patients pending transfer. In July 2020, a clinical data repository ("Transfer Log") updated daily by accepting providers (attending physicians and subspecialty fellows) became available to senior medicine residents responsible for triage.
Likert scale surveys were administered to housestaff before email intervention (pre) and after transfer log intervention (post). The time from patient arrival to team assignment (TTA) in the electronic medical record was used as a proxy for time to patient assessment and was measured pre- and postinterventions; >2 hours to TTA was considered an extreme delay.
Housestaff reported frequency of access to clinical information as follows: preinterventions 4/31 (13%) sometimes/very often and 27/31 (87%) never/rarely; postinterventions 11/26 (42%) sometimes/very often and 15/26 (58%) never/rarely ( = 0.02). Preinterventions 12/39 (31%) felt "not at all prepared" versus 27/39 (69%) "somewhat" or "adequately"; postinterventions 2/24 (8%) felt "not at all prepared" versus 22/24 (92%) somewhat/adequately prepared ( = 0.06). There was a significant difference in mean TTA between pre- and posttransfer log groups (62 vs. 40 minutes, = 0.01) and a significant reduction in patients with extreme delays in TTA post-email (18/180 pre-email vs. 7/174 post-email, = 0.04).
Early notification and increased access to clinical information were associated with better sense of preparedness for admitting housestaff, reduction in TTA, and reduced frequency of extreme delays in team assignment.
本质量改进项目旨在增强向由内科住院医师一线提供者（住院医师）组成的住院肝病服务转院的临床信息共享，具体目标是使住院医师了解 100%的转入患者，并及时获得临床总结。
2020 年 2 月，向负责患者分诊的内科住院医师高级管理人员发送电子邮件通知系统，共享待转患者的计划到达时间。2020 年 7 月，一个由接受提供者（主治医生和亚专科研究员）每日更新的临床数据存储库（“转科日志”）可供负责分诊的内科住院医师高级管理人员使用。
在电子邮件干预前（预）和转科日志干预后（后），对住院医师进行李克特量表调查。电子病历中从患者到达到团队分配的时间（TTA）被用作评估患者时间的代理指标，并在干预前后进行测量；TTA 超过 2 小时被认为是极端延迟。
住院医师报告获取临床信息的频率如下：干预前 4/31（13%）有时/经常，27/31（87%）从不/很少；干预后 11/26（42%）有时/经常，15/26（58%）从不/很少（ = 0.02）。干预前 12/39（31%）感觉“一点也不准备”，而 27/39（69%）感觉“有点”或“足够”；干预后 2/24（8%）感觉“一点也不准备”，而 22/24（92%）感觉“有点”或“足够”（ = 0.06）。转科日志前后组 TTA 的平均差异有统计学意义（62 分钟比 40 分钟， = 0.01），并且转科日志后 TTA 极端延迟的患者明显减少（18/180 转科前电子邮件比 7/174 转科后电子邮件， = 0.04）。
提前通知和增加获取临床信息的机会与提高住院医师的准备程度、缩短 TTA 以及减少团队分配的极端延迟频率有关。
