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Ward MJ, Kripalani S, Muñoz D, Collins SP, Moser K, Jenkins CA, Liu D, Vogus TJ. Association of Physician Coordination With Interfacility Transfer Acceptance Timeliness. AMERICAN JOURNAL OF ACCOUNTABLE CARE 2022; 10:7-15. [PMID: 38617098 PMCID: PMC11014424 DOI: 10.37765/ajac.2022.89231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Objectives Interfacility transfer for time-sensitive emergencies involves rapid and complex care transitions between facilities. We sought to validate relational coordination, a 7-dimension measure of coordination in which a higher score reflects higher-quality coordination, to examine how the quality of coordination affects timeliness in an emergency care setting. Study Design Retrospective observational cohort design. Methods We used a novel method to examine how the quality of coordination between physicians at the time of transfer affects timeliness of physician acceptance. We recorded physician-to-physician conversations from the transfer of patients with ST-segment elevation myocardial infarction (STEMI), a time-sensitive emergency requiring immediate intervention to prevent morbidity and mortality. Results We identified 81 patients experiencing STEMI who were transferred between August 1, 2016, and March 31, 2018. Descriptive statistics, interrater reliability (Spearman correlation coefficients), and generalized linear models were used to examine the association between relational coordination and the physician time-to-acceptance duration. Median (IQR) relational coordination score was 445 (403-493) of a maximum of 700, and median (IQR) time to acceptance was 90.4 (60.2-140.8) seconds. Agreement between abstractors was high (ρ = 0.76). There was a significant, negative relationship between relational coordination and time to acceptance (ρ = -0.38; P < .001). Every 40-point increase in relational coordination was associated with a 25% reduction in time to acceptance. Conclusions Relational coordination not only demonstrated high interrater reliability, but we also found that higher-quality coordination was associated with faster physician acceptance during time-sensitive transfers. Use of such measures may provide a mechanism to improve the quality of care and outcomes for patients with STEMI who experience interfacility transfers.
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Affiliation(s)
- Michael J Ward
- Department of Emergency Medicine (MJW, SPC, KM) and Department of Biomedical Informatics (MJW), Vanderbilt University Medical Center, Nashville, TN; Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee (MJW, SPC), Nashville, TN; Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Center for Clinical Quality and Implementation Research, Vanderbilt University School of Medicine (SK), Nashville, TN; Division of Cardiology, Vanderbilt University School of Medicine (DM), Nashville, TN; Department of Biostatistics, Vanderbilt University School of Medicine (CAJ, DL), Nashville, TN; Owen Graduate School of Management, Vanderbilt University (TJV), Nashville, TN
| | - Sunil Kripalani
- Department of Emergency Medicine (MJW, SPC, KM) and Department of Biomedical Informatics (MJW), Vanderbilt University Medical Center, Nashville, TN; Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee (MJW, SPC), Nashville, TN; Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Center for Clinical Quality and Implementation Research, Vanderbilt University School of Medicine (SK), Nashville, TN; Division of Cardiology, Vanderbilt University School of Medicine (DM), Nashville, TN; Department of Biostatistics, Vanderbilt University School of Medicine (CAJ, DL), Nashville, TN; Owen Graduate School of Management, Vanderbilt University (TJV), Nashville, TN
| | - Daniel Muñoz
- Department of Emergency Medicine (MJW, SPC, KM) and Department of Biomedical Informatics (MJW), Vanderbilt University Medical Center, Nashville, TN; Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee (MJW, SPC), Nashville, TN; Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Center for Clinical Quality and Implementation Research, Vanderbilt University School of Medicine (SK), Nashville, TN; Division of Cardiology, Vanderbilt University School of Medicine (DM), Nashville, TN; Department of Biostatistics, Vanderbilt University School of Medicine (CAJ, DL), Nashville, TN; Owen Graduate School of Management, Vanderbilt University (TJV), Nashville, TN
| | - Sean P Collins
- Department of Emergency Medicine (MJW, SPC, KM) and Department of Biomedical Informatics (MJW), Vanderbilt University Medical Center, Nashville, TN; Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee (MJW, SPC), Nashville, TN; Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Center for Clinical Quality and Implementation Research, Vanderbilt University School of Medicine (SK), Nashville, TN; Division of Cardiology, Vanderbilt University School of Medicine (DM), Nashville, TN; Department of Biostatistics, Vanderbilt University School of Medicine (CAJ, DL), Nashville, TN; Owen Graduate School of Management, Vanderbilt University (TJV), Nashville, TN
| | - Kelly Moser
- Department of Emergency Medicine (MJW, SPC, KM) and Department of Biomedical Informatics (MJW), Vanderbilt University Medical Center, Nashville, TN; Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee (MJW, SPC), Nashville, TN; Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Center for Clinical Quality and Implementation Research, Vanderbilt University School of Medicine (SK), Nashville, TN; Division of Cardiology, Vanderbilt University School of Medicine (DM), Nashville, TN; Department of Biostatistics, Vanderbilt University School of Medicine (CAJ, DL), Nashville, TN; Owen Graduate School of Management, Vanderbilt University (TJV), Nashville, TN
| | - Cathy A Jenkins
- Department of Emergency Medicine (MJW, SPC, KM) and Department of Biomedical Informatics (MJW), Vanderbilt University Medical Center, Nashville, TN; Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee (MJW, SPC), Nashville, TN; Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Center for Clinical Quality and Implementation Research, Vanderbilt University School of Medicine (SK), Nashville, TN; Division of Cardiology, Vanderbilt University School of Medicine (DM), Nashville, TN; Department of Biostatistics, Vanderbilt University School of Medicine (CAJ, DL), Nashville, TN; Owen Graduate School of Management, Vanderbilt University (TJV), Nashville, TN
| | - Dandan Liu
- Department of Emergency Medicine (MJW, SPC, KM) and Department of Biomedical Informatics (MJW), Vanderbilt University Medical Center, Nashville, TN; Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee (MJW, SPC), Nashville, TN; Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Center for Clinical Quality and Implementation Research, Vanderbilt University School of Medicine (SK), Nashville, TN; Division of Cardiology, Vanderbilt University School of Medicine (DM), Nashville, TN; Department of Biostatistics, Vanderbilt University School of Medicine (CAJ, DL), Nashville, TN; Owen Graduate School of Management, Vanderbilt University (TJV), Nashville, TN
| | - Timothy J Vogus
- Department of Emergency Medicine (MJW, SPC, KM) and Department of Biomedical Informatics (MJW), Vanderbilt University Medical Center, Nashville, TN; Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee (MJW, SPC), Nashville, TN; Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Center for Clinical Quality and Implementation Research, Vanderbilt University School of Medicine (SK), Nashville, TN; Division of Cardiology, Vanderbilt University School of Medicine (DM), Nashville, TN; Department of Biostatistics, Vanderbilt University School of Medicine (CAJ, DL), Nashville, TN; Owen Graduate School of Management, Vanderbilt University (TJV), Nashville, TN
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Sanchez MA, Vuagnat A, Grimaud O, Leray E, Philippe JM, Lescure FX, Boutonnet M, Coignard H, Hibon AR, Sanchez S, Pottecher J. Impact of ICU transfers on the mortality rate of patients with COVID-19: insights from comprehensive national database in France. Ann Intensive Care 2021; 11:151. [PMID: 34698966 PMCID: PMC8546754 DOI: 10.1186/s13613-021-00933-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/28/2021] [Indexed: 12/19/2022] Open
Abstract
Background The first wave of the COVID-19 pandemic confronted healthcare systems around the world with unprecedented organizational challenges, particularly regarding the availability of intensive care unit (ICU) beds. One strategy implemented in France to alleviate healthcare pressure during the first COVID-19 wave was inter-hospital transfers of selected ICU patients from overwhelmed areas towards less saturated ones. At the time, the impact of this transfer strategy on patient mortality was unknown. We aimed to compare in-hospital mortality rates among ICU patients with COVID-19 who were transferred to another healthcare facility and those who remained in the hospital where they were initially admitted to. Method A prospective observational study was performed from 1 March to 21 June 2020. Data regarding hospitalized patients with COVID-19 were collected from the Ministry of Health-affiliated national SI-VIC registry. The primary endpoint was in-hospital mortality. Results In total, 93,351 hospital admissions of COVID-19 patients were registered, of which 18,348 (19.6%) were ICU admissions. Transferred patients (n = 2228) had a lower mortality rate than their non-transferred counterparts (n = 15,303), and the risk decreased with increasing transfer distance (odds ratio (OR) 0.7, 95% CI: 0.6–0.9, p = 0.001 for transfers between 10 and 50 km, and OR 0.3, 95% CI: 0.2–0.4, p < 0.0001 for transfer distance > 200 km). Mortality decreased overall over the 3-month study period. Conclusions Our study shows that the mortality rates were lower for patients with severe COVID-19 who were transferred between ICUs across regions, or internationally, during the first pandemic wave in France. However, the global mortality rate declined overall during the study. Transferring selected patients with COVID-19 from overwhelmed regions to areas with greater capacity may have improved patient access to ICU care, without compounding the short-term mortality risk of transferred patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00933-2.
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Affiliation(s)
- Marc-Antoine Sanchez
- Information Systems and Digital Department (DSIN), French Army Health Service, Saint Mandé-Bat 14, 69 avenue de Paris, 94165, Saint-Mandé, France. .,Central Directorate of the Military Health Service (DCSSA), French Army Health Service, Paris, France.
| | - Albert Vuagnat
- Department for Research, Studies, Evaluation and Statistics (DREES), French Health and Social Affairs Ministry, Paris, France
| | - Olivier Grimaud
- Univ Rennes, EHESP, REPERES(Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449, Rennes, France
| | - Emmanuelle Leray
- Univ Rennes, EHESP, REPERES(Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449, Rennes, France
| | - Jean-Marc Philippe
- General Directorate for Health (DGS)-French Health and Social Affairs Ministry, Paris, France
| | - François-Xavier Lescure
- Tropical and Infectious Disease Services, Bichat AP HP, Paris, France.,INSERM 1137, Paris Diderot University, Paris, France
| | - Mathieu Boutonnet
- Department of Anesthesiology and Intensive Care Unit, Percy Military Teaching Hospital, Clamart, France
| | - Hélène Coignard
- Emergency Medical Service, Lyon University Hospital, Lyon, France
| | | | - Stephane Sanchez
- Department of Public Health and Performance, Troyes Hospital, Champagne Sud Hospital, Troyes, France
| | - Julien Pottecher
- Anaesthesiology, Critical Care and Perioperative Medicine, Strasbourg University Hospital-EA3072, FMTS, Strasbourg, France
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