Improving The Safety of Outside Hospital Admission Process to Neilson Rehabilitation Hospital. A QI Project

Neilson Rehabilitation Hospital (NRH) at the University of Utah is committed to becoming a national rehab presence that accepts medically complex patients. This QI project was based on an OSH admission that arrived in unstable condition and required rapid transfer to the MICU. QI Process Problem Statement: Medical instability of patients admitted from outside hospitals is not uncommon; subsequent acute transfers have significant detrimental impacts not just on patients and care team members at NRH but many other aspects of the University of Utah hospital system. Areas for Improvement: Lack of timely record review and Doc to Doc with OSH led to patients being transferred to NRH in an unknowingly unstable condition. Multiple areas of communication breakdown were identified. Intervention: Restructured the Senior resident rotation to incorporate a timely review of OSH admissions. This included full records obtained and Doc to Doc performed at least 24 hours prior to; admission. Project Analysis Survey results indicated the senior resident had a thorough understanding of the OSH patient and was able to complete record reviews/doc-to-doc in a timely fashion in order to prevent unsafe OSH transfers and address patient safety issues on arrival.