Top

BMC Health Services Research

Published in:

Open Access 01-12-2016 | Study protocol

Implementation of a Transfer Intervention Procedure (TIP) to improve handovers from hospital to home: interrupted time series analysis

Authors: Rosanne van Seben, Suzanne E. Geerlings, Kim J. M. Verhaegh, Carina G. J. M. Hilders, Bianca M. Buurman

Published in: BMC Health Services Research | Issue 1/2016

Abstract

Background

Accurate and timely patient handovers from hospital to other health care settings are essential in order to provide high quality of care and to ensure patient safety. We aim to investigate the effect of a comprehensive discharge bundle, the Transfer Intervention Procedure (TIP), on the time between discharge and the time when the medical, medication and nursing handovers are sent to the next health care provider. Our goal is to reduce this time to 24 h after hospital discharge. Secondary outcomes are length of hospital stay and unplanned readmission within 30 days rates.

Methods

The current study is set to implement the TIP, a structured discharge process for all patients admitted to the hospital, with the purpose to provide a safe, reliable and accurate discharge process. Eight hospitals in the Netherlands will implement the TIP on one internal medicine and one surgical ward. An interrupted time series (ITS) analysis, with pre-defined pre and post intervention periods, will be conducted. Patients over the age of 18 admitted for more than 48 h to the participating wards are eligible for inclusion. At least 1000 patients will be included in both the pre-implementation and post-implementation group. The primary outcome is the number of medical, medication and nursing handovers being sent within 24 h after discharge. Secondary outcomes are length of hospital stay and unplanned readmission within 30 days. With regard to potential confounders, data will be collected on patient’s characteristics and information regarding the hospitalization. We will use segmented regression methods for analyzing the data, which allows assessing how much TIP changed the outcomes of interest immediately and over time.

Discussion

This study protocol describes the implementation of TIP, which provides the foundation for a safe, reliable and accurate discharge process. If effective, nationwide implementation of the discharge bundle may result from this study protocol.

Trial Registration

Dutch Trial Registry: NTR5951

Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007;297(8):831–41.CrossRefPubMed

Henderson A, Zernike W. A study of the impact of discharge information for surgical patients. J Adv Nurs. 2001;35(3):435–41.CrossRefPubMed

Holland DE, Mistiaen P, Bowles KH. Problems and unmet needs of patients discharged “home to self-care”. Prof Case Manag. 2011;16(5):240–50. quiz 51-2.CrossRefPubMed

Mechanic R. Post-acute care--the next frontier for controlling Medicare spending. N Engl J Med. 2014;370(8):692–4.CrossRefPubMed

Coleman EA, Berenson RA. Lost in transition: challenges and opportunities for improving the quality of transitional care. Ann Intern Med. 2004;141(7):533–6.CrossRefPubMed

Hesselink G, Vernooij-Dassen M, Pijnenborg L, Barach P, Gademan P, Dudzik-Urbaniak E, et al. Organizational culture: an important context for addressing and improving hospital to community patient discharge. Med Care. 2013;51(1):90–8.CrossRefPubMed

Greenwald JL, Jack BW. Preventing the preventable: reducing rehospitalizations through coordinated, patient-centered discharge processes. Prof Case Manag. 2009;14(3):135–40. quiz 41-2.CrossRefPubMedPubMedCentral

Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet (London, England). 2012;380(9836):37–43.CrossRef

Hesselink G, Schoonhoven L, Barach P, Spijker A, Gademan P, Kalkman C, et al. Improving patient handovers from hospital to primary care: a systematic review. Ann Intern Med. 2012;157(6):417–28.CrossRefPubMed

10.

Prvu Bettger J, Alexander KP, Dolor RJ, Olson DM, Kendrick AS, Wing L, et al. Transitional care after hospitalization for acute stroke or myocardial infarction: a systematic review. Ann Intern Med. 2012;157(6):407–16.CrossRefPubMed

11.

Verhaegh KJ, MacNeil-Vroomen JL, Eslami S, Geerlings SE, de Rooij SE, Buurman BM. Transitional care interventions prevent hospital readmissions for adults with chronic illnesses. Health Aff (Project Hope). 2014;33(9):1531–9.CrossRef

12.

Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gotzsche PC, Krleza-Jeric K, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158(3):200–7.CrossRefPubMedPubMedCentral

13.

Penfold RB, Zhang F. Use of interrupted time series analysis in evaluating health care quality improvements. Acad Pediatr. 2013;13(6 Suppl):S38–44.CrossRefPubMed

14.

Jandoc R, Burden AM, Mamdani M, Levesque LE, Cadarette SM. Interrupted time series analysis in drug utilization research is increasing: systematic review and recommendations. J Clin Epidemiol. 2015;68(8):950–6.CrossRefPubMed

15.

Halasyamani L, Kripalani S, Coleman E, Schnipper J, van Walraven C, Nagamine J, et al. Transition of care for hospitalized elderly patients--development of a discharge checklist for hospitalists. J Hosp Med. 2006;1(6):354–60.CrossRefPubMed

16.

Verhaegh KJ, Buurman BM, Veenboer GC, de Rooij SE, Geerlings SE. The implementation of a comprehensive discharge bundle to improve the discharge process: a quasi-experimental study. Neth J Med. 2014;72(6):318–25.PubMed

17.

Guest G, Bunce A, Johnson L. How many interviews are enough? an experiment with data saturation and variability. Field Methods. 2006;18(1):59–82.CrossRef

18.

Bowen GA. Grounded theory and sensitizing concepts. International journal of qualitative methods. 2006;5(3).

19.

Patton M. Qualitative Analysis and Interpretation. In: Qualitative Reserach & Ecaluation Methods. California: Sage Publications; 1990. p. 431-525.

20.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRefPubMed

Title: Implementation of a Transfer Intervention Procedure (TIP) to improve handovers from hospital to home: interrupted time series analysis
Authors: Rosanne van Seben
Suzanne E. Geerlings
Kim J. M. Verhaegh
Carina G. J. M. Hilders
Bianca M. Buurman
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-016-1730-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Implementation of a Transfer Intervention Procedure (TIP) to improve handovers from hospital to home: interrupted time series analysis

Abstract

Background

Methods

Discussion

Trial Registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Discussion

Trial Registration

Please log in to get access to this content

Other articles of this Issue 1/2016

Causes of cancellations on the day of surgery at a Tertiary Teaching Hospital

The patient reporting and action for a safe environment (PRASE) intervention: a feasibility study

Advancing a new evidence-based professional in health care: job task analysis for health and wellness coaches

Health care utilization and outpatient, out-of-pocket costs for active convulsive epilepsy in rural northeastern South Africa: a cross-sectional Survey

Modification of claims-based measures improves identification of comorbidities in non-elderly women undergoing mastectomy for breast cancer: a retrospective cohort study

Performance-based financing in the context of the complex remuneration of health workers: findings from a mixed-method study in rural Sierra Leone