Provider Perceptions of the Tele Critical Care Patient Transfer Process

Background: Research has demonstrated how interfacility transfer of critically ill patients can be associated with adverse outcomes. A tele critical care (TCC) driven patient transfer process has been instituted by a large hospital system based in the intermountain west, but at this time it has not been evaluated. The purpose of the project is to evaluate provider perceptions of the effectiveness of the TCC patient transfer process. Perceptions were solicited from 3 groups: sending providers, receiving providers, and the TCC providers who coordinated the transfers.Methods: The perceptions of the providers were evaluated via an email survey. The survey was developed to analyze overall impressions of the process's effectiveness along with factors shown in the literature to contribute to a successful transfer. These factors can include: optimizing patient prior to transfer, selecting an appropriate receiving facility, timeliness of transport, facilitating clear communication, efficiency of the acceptance process. Surveys (n=189) were distributed to providers involved in TCC driven patient transfer processes over the course of 3 continuous months. Responses (n=45) were received which contained both quantitative data on different dimensions of program effectiveness and qualitative data in the form of free-text responses. Results were compared among the 3 provider types with a statistical significance of p=0.05.Results: No statistically significant difference was noted in responses between provider types. The majority of respondents felt that the transfer process was an improvement over the previous process at 67.4 percent (n=29). All provider types had mean ratings effectiveness at >70 in all categories except for communication. Qualitative responses revealed 37 themes and subthemes in the following categories: negative themes at 29.7 percent(n=11), positive themes at 45.9% (n=17), with suggestions at 24.3%(n=9). Results were disseminated to key stakeholders in a formal presentation.Conclusions: Despite lack of statistical significance the results were meaningful for the TCC patient transfer process. Overall perceptions were positive in most of the factors associated with a successful transfer; communication was highlighted as an area for improvement. Free text responses and meeting with stakeholders provided several potential interventions TCC could implement in their workflow. The results also helped identify more meaningful questions to potentially further improve the process. Initial results are promising that this TCC driven process is effective but further research is warranted to determine its impact on patient outcomes.