President, Innovative Healthcare Solutions, Inc.

Dissertation Title

The relationship between hospital interdepartmental transfers and patient experience

Dissertation Abstract

This study examined the potential relationship between interdepartmental transfers and perceptions of the care received by adult patients who were admitted and discharged from a 300-bed, not-for-profit community tertiary hospital in the Midwest. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a publically reported comparative data tool measuring hospital patient experiences. As consumers, patients are more informed about their own health and are challenging the quality and service of care provided by hospitals. The value-based purchasing reimbursement model has become a new challenge for hospitals. Historically, hospitals were reimbursed through a volume driven model. Comparatively, the value-based model focuses on the quality and efficiency of care perceived by the patient. This shift of emphasis for hospitals creates an opportunity to evaluate hospital operations.

The Value-Based Theory was utilized as a framework to examine 12 hypotheses regarding patient experiences and interdepartmental hospital transfers. Handoffs and transfers of patient care are daily routines that occur in hospitals. Problems can arise when the responsibility for patient care is transferred from one healthcare professional or groups of professionals to another group during intra-hospital transfer of patients from one unit to another unit (e.g., inpatient unit to radiology; Emergency Department to inpatient unit).

The logistic regression models used in this study assessed the relationship between transfers and patient perceptions of their care. The main independent variable of interest was the number of intra-hospital transfers experienced by each subject during their inpatient hospital stay: (1) Transfer0 (no transfers – reference category); (2) Transfer1 (one transfer); (3) Transfer2 (two transfers); and (4) Transfer3 (three or more transfers).

The results of the study showed statistically significant relationships of nursing communication, doctor communication, responsiveness to the call button, quietness, cleanliness and recommending the hospital to number of transfers. Further, the control variables had several statistically significant relationships with interdepartmental transfers. This study provides a framework for the application of these findings to be utilized by healthcare executives to determine quality and efficiency strategies.

The recent research literature on patient centered care focuses heavily on HCAHPS and the value-based purchasing model. There is paucity, however, in evaluation of hospital operations in delivery of care. Little attention has focused on the effect that intra-hospital handoffs and transfers of care have on the patient experience. This effect is important since value-based purchasing models of hospital reimbursements are partially determined by patient experiences.