Presentation
HE13 - Factors Affecting Staffing Demands Associated With Intrahospital Transfers: A Pilot Study
SessionPoster Session 2
DescriptionIntrahospital transfers (IHTs), which involve transporting patients from one unit to another within a hospital, are frequent occurrences that have substantial impact on patient safety and hospital operations. Patient safety complications of IHTs include an increased rate of hospital-acquired infections, and a higher incidence of patient falls. In addition to patient safety concerns, IHTs disrupt hospital efficiency by demanding significant staffing resources and reducing room utilization. Although some researchers quantified nursing time during transfers, no studies have quantified all clinical staff time required to complete the transfer process. Furthermore, no recent studies have quantified the effects of IHTs on room utilization. These circumstances include "dead bed time”, the time during which two rooms remain unavailable due to the transfer process, and time of “non-optimal care”, during which hospital resources are either over-utilized or under-utilized while waiting for a patient to transfer to a lower or higher acuity of care.
This study aimed to quantify the impact of IHTs on hospital operations by quantifying staff time requirements, identifying key subtasks, and measuring the effect on room utilization. Staff time and subtasks associated with IHTs were quantified through direct observation. IHT impacts on room utilization will be evaluated through analysis of historical bed transfer records, which is ongoing. The findings are expected to help identify inefficiencies in the transfer process, which could lead to improvements in patient safety and staff workflow.
Fifty complete IHTs (39 between unit, 11 within unit) were observed by one or both of the same two observers at a 718-bed level 1 trauma hospital. Before formal data collection, seven IHTs were observed as a pilot to categorize subtasks and establish consistent methods for measuring staff time. Fourteen subtasks were identified to categorize the major activities during an IHT.
Before each IHT, observers monitored a status board of the hospital bed assignment system to ensure they reached the unit before transfer tasks began. Staff were shadowed for all observable elements of the transfer process from the origin to the destination unit. In addition to the times that staff were involved in the transfer, contextual data about the transfer, such as origin and destination units, were also collected.
Descriptive statistics were generated to describe the amount of time spent by nurses, techs, and other staff on each activity within the IHT. A standard least squares regression evaluated the effect of independent variables on staff time and nurse time. These independent variables were elevator use (yes/no), change in acuity (upgrade/downgrade/no change), nurse-reported workload estimate (1-10 scale), estimate of personal belongings (below average, average, above average), isolation precautions (yes/no), cardiorespiratory monitoring (yes/no), telemetry monitoring (yes/no), time of day (10:00-13:00/13:01-15:00/15:01-18:00), and transport equipment (bed/transport chair/wheelchair).
On average, the elapsed time to complete the transfer, was a mean of 70 minutes. However, the total time spent by all staff members for each transfer averaged 77 minutes, reflecting the additional coordination required among various team members. Of particular note, nurse time averaged 53 minutes, or 75% of the total staff time required for the transfer. The subtask requiring the most was managing patient belongings, supplies, and equipment, followed by handoff communication.
The result of the regression analysis indicated that both elevator use and acuity had a
significant impact on IHT times. Elevator use increased staff time from an average of 50 to 89 minutes (p=.03) and nurse time from 27 to 65 minutes (p = 0.0006). A change in level of acuity affected staff time (p=.03) and nurse time (p<.0001). The post-hoc Tukey-HSD test further revealed a significant increase in staff time (p = 0.03, mean difference = 48 minutes) and nurse time (p <.0001, mean difference = 74 minutes) from the no change in acuity level to increase in acuity level conditions. The increased staff time required for a transfer of upgrade in acuity was likely because more staff accompanied the patient in the event of sudden patient deterioration. Further, more medical equipment and more information to relay during handoff could have contributed.
In addition to the measurements of staff time, many pain points and nonstandard workflows were observed that provide opportunity for improving the IHT process. When transfers were scheduled during shift changes, outgoing nurses struggled to find their replacements, increasing the time of the transfer and the risk that critical patient information was not communicated. Because specialized ICU beds were not allowed to remain in other units to which patients were transferred, ICU staff spent more time off the floor retrieving beds. The transport of bariatric beds was particularly time-consuming, and their nonstandard size complicated maneuverability through certain doorways and elevators. When transferring isolation patients, a cart containing personal protective equipment needed to be transported separately, and staff donned and doffed PPE, often requiring more staff and time. Lastly, in four instances a soiled room was incorrectly communicated as clean and available, further increasing staff time to complete a transfer.
In addition to the findings from direct observation, analysis of 12 months of bed transfer records is ongoing. Together, these findings highlight key tasks performed by hospital staff, identify factors that extend the transfer process, and pinpoint pain points that affect efficiency.
This study aimed to quantify the impact of IHTs on hospital operations by quantifying staff time requirements, identifying key subtasks, and measuring the effect on room utilization. Staff time and subtasks associated with IHTs were quantified through direct observation. IHT impacts on room utilization will be evaluated through analysis of historical bed transfer records, which is ongoing. The findings are expected to help identify inefficiencies in the transfer process, which could lead to improvements in patient safety and staff workflow.
Fifty complete IHTs (39 between unit, 11 within unit) were observed by one or both of the same two observers at a 718-bed level 1 trauma hospital. Before formal data collection, seven IHTs were observed as a pilot to categorize subtasks and establish consistent methods for measuring staff time. Fourteen subtasks were identified to categorize the major activities during an IHT.
Before each IHT, observers monitored a status board of the hospital bed assignment system to ensure they reached the unit before transfer tasks began. Staff were shadowed for all observable elements of the transfer process from the origin to the destination unit. In addition to the times that staff were involved in the transfer, contextual data about the transfer, such as origin and destination units, were also collected.
Descriptive statistics were generated to describe the amount of time spent by nurses, techs, and other staff on each activity within the IHT. A standard least squares regression evaluated the effect of independent variables on staff time and nurse time. These independent variables were elevator use (yes/no), change in acuity (upgrade/downgrade/no change), nurse-reported workload estimate (1-10 scale), estimate of personal belongings (below average, average, above average), isolation precautions (yes/no), cardiorespiratory monitoring (yes/no), telemetry monitoring (yes/no), time of day (10:00-13:00/13:01-15:00/15:01-18:00), and transport equipment (bed/transport chair/wheelchair).
On average, the elapsed time to complete the transfer, was a mean of 70 minutes. However, the total time spent by all staff members for each transfer averaged 77 minutes, reflecting the additional coordination required among various team members. Of particular note, nurse time averaged 53 minutes, or 75% of the total staff time required for the transfer. The subtask requiring the most was managing patient belongings, supplies, and equipment, followed by handoff communication.
The result of the regression analysis indicated that both elevator use and acuity had a
significant impact on IHT times. Elevator use increased staff time from an average of 50 to 89 minutes (p=.03) and nurse time from 27 to 65 minutes (p = 0.0006). A change in level of acuity affected staff time (p=.03) and nurse time (p<.0001). The post-hoc Tukey-HSD test further revealed a significant increase in staff time (p = 0.03, mean difference = 48 minutes) and nurse time (p <.0001, mean difference = 74 minutes) from the no change in acuity level to increase in acuity level conditions. The increased staff time required for a transfer of upgrade in acuity was likely because more staff accompanied the patient in the event of sudden patient deterioration. Further, more medical equipment and more information to relay during handoff could have contributed.
In addition to the measurements of staff time, many pain points and nonstandard workflows were observed that provide opportunity for improving the IHT process. When transfers were scheduled during shift changes, outgoing nurses struggled to find their replacements, increasing the time of the transfer and the risk that critical patient information was not communicated. Because specialized ICU beds were not allowed to remain in other units to which patients were transferred, ICU staff spent more time off the floor retrieving beds. The transport of bariatric beds was particularly time-consuming, and their nonstandard size complicated maneuverability through certain doorways and elevators. When transferring isolation patients, a cart containing personal protective equipment needed to be transported separately, and staff donned and doffed PPE, often requiring more staff and time. Lastly, in four instances a soiled room was incorrectly communicated as clean and available, further increasing staff time to complete a transfer.
In addition to the findings from direct observation, analysis of 12 months of bed transfer records is ongoing. Together, these findings highlight key tasks performed by hospital staff, identify factors that extend the transfer process, and pinpoint pain points that affect efficiency.
Event Type
Poster Presentation
TimeTuesday, April 14:45pm - 6:15pm EDT
LocationFrontenac Foyer