By Darin Vercillo, MD
Patient transfers are among healthcare’s riskiest events, with potential for complications stemming from misunderstandings around multiple factors, such as the patient’s true medical state, medications the patient may be on or previously prescribed, and questions about where one provider’s responsibility begins and another’s ends.
For patients, handoffs that go poorly can lead to serious medical consequences, and, unfortunately, even death. For providers, they can create significant personal stress, legal liability, reputational harm, and financial loss.
One notable and high-profile case of a transfer gone awry that caused considerable consternation in the medical industry and eventually found its way to a state supreme court involved a Minnesota patient in 2014. A nurse practitioner at a clinic called the local hospital, Fairview Range Medical Center, and asked a hospitalist to have a 54-year-old patient admitted because the patient was experiencing abdominal pain, fever, and chills.
A 10-minute conversation ensued, and ended with the physician denying admission, though many aspects of the conversation are in dispute, including whether a formal admitting request was made. The patient was sent home, where she was found dead three days later, with an autopsy later determining that she died from sepsis caused by an untreated staph infection. The inability to clearly demonstrate what processes and decisions took place was a key factor in this case. The Minnesota Supreme Court ruled that the doctor and facility that denied admission could be sued for malpractice.
Over time the industry has evolved towards a solution to help avoid similar calamities. Transfer centers, which specialize in patient transfers and have established the processes, technologies, standards, and workflows to optimize them, exist to help mitigate many of the problems endemic to the transfer process.
The challenges of patient transfers
Potential for patient safety issues during transfers often occurs when the accepting provider gets information that is inaccurate, incomplete, not timely, or otherwise of poor clinical value. Common causes of problems with patient transfers include provider training and expectations, language barriers, cultural or ethnic considerations, and inadequate, incomplete, or nonexistent documentation, according to the Joint Commission.
When it comes to transfers, virtually everyone involved is concerned about liability, and their fears are greatest when events are out of their control. Accepting providers sometimes fear that patients who are uninsured, or those with inherently poor outcomes, will be prioritized for transfer to their facilities. While evidence does not support the idea that uninsured patients are more likely to be transferred, it is true that complex cases are more frequently subject to transfer. Clearly, the referring provider does not have the resources, experience, or technology in place to care for the patient; otherwise, there would be no need for the transfer in the first place.