COLLABORATION BETWEEN A REFERRING HOSPITAL AND A TERTIARY CARE CENTERIN IMPROVING THE TRANSFER PROCESS FOR CARDIAC PATIENTS

Background: Transfer of cardiac patients between hospitals is a comple x process with many implications for quality of care. In the case of h eart disease, specialized procedures such as coronary angioplasty, cor onary bypass surgery, and valve replacement or repair require the perf ormance of cardiac catheterization and coronary arteriography in a cat heterization laboratory, as well as the availability of cardiac surgic al services. The Department of Veterans Affairs Medical Center (DVAMC) at Muskogee, Oklahoma, transfers most cardiac patients requiring spec ialized diagnostic procedures and advanced cardiac care to DVAMC at Ok lahoma City, Oklahoma. Concerns about the inefficiency of the transfer process led to the launch of a quality improvement project in late 19 92. Changes in the transfer process: Greater emphasis was placed on me dical aspects compared to administrative aspects of transfer, and read y access to the physicians at DVAMC at Oklahoma City was provided. Res ults: The time from request for transfer to the actual transfer decrea sed. Before the quality improvement project, only 33% of transfers of cardiac patients were completed within 24 hours-versus 78% in 1993 and 1994, 89% in 1995, and 84% in the first half of 1996. In addition, DV AMC-Muskogee physician satisfaction regarding services at DVAMC-Oklaho ma City improved. Conclusion: Ongoing discussion between the cardiolog y team at the accepting hospital and physicians at the referring hospi tal expanded the continuum of care to both hospitals. Priority of tran sfers could be upgraded at any time without unduly jeopardizing patien t safety or increasing resource utilization at the receiving center.