Development of a Tool to Measure Potentially Inappropriate Inter-Hospital Transfer (IHT): The POINT Study.

Background: Although inter-hospital transfer (IHT, the transfer of patients between acute care hospitals) aims at matching patients' care needs to appropriate sites of care, IHT practices are variable leaving some patients vulnerable to risks of discontinuity of care without clear benefit. Identifying which patients may not need IHT can help to prevent inappropriate care and improve patient outcomes.

Study overview: The POINT Study, "Identification and Prevention of Potentially Inappropriate Inter-Hospital Transfers," is a 5-year study (AHRQ-R01HS028621) that aims to define potentially inappropriate IHT using key stakeholder input, evaluate the incidence and patient safety impact of potentially inappropriate IHT across a nationally representative sample of 18 hospitals, and develop an intervention toolkit to reduce potentially inappropriate IHT. In this paper, we report on the development of a standardized adjudication process to capture potentially inappropriate IHT using results generated from the first 2 years of this project.

Development of the adjudication tool: Development of the adjudication tool to measure potentially inappropriate IHT involved a multi-step process, including (1) conducting focus groups of key stakeholders involved in IHT to generate a consensus definition of "potentially inappropriate IHT;" (2) translating this definition into an adjudication tool for use during retrospective chart review; and (3) conducting rigorous training among all adjudicators to ensure reliability of the adjudication process.

Next steps: Next steps include launching sites to conduct adjudications with a goal of 1800 total transfer case adjudications across the 18 sites. We will support the adjudication process with monthly tracking and case review meetings among other supports. The results of this work will lead to a foundational understanding of the prevalence, risk factors, and patient safety impact of potentially inappropriate IHT.