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please phone 03 9096 1388 using the National Relay Service 13 3677 if required, or email vqc@health.vic.gov.au This document is available as a PDF on the internet at: www.health.vic.gov.au/qualitycouncil Copyright, State of Victoria, Department of Health, 2012 This publication is copyright, no part may be reproduced by any process except in accordance with the provisions of the Copyright Act 1968. Authorised and published by the Victorian Government, 50 Lonsdale Street, Melbourne. Except where otherwise indicated, the images in this publication show models and illustrative settings only, and do not necessarily depict actual services, facilities or recipients of services. December 2012 (1211033) GUIDE TO PATIENT TRANSFER 1 A c k n o w l e d g e m e n t s The development of this Guide to patient transfer: principles and minimum requirements for nontime critical inter-hospital patient transfer was prepared by Alice Gleeson and overseen by the VQC Patient Transfer Group. The group consists of two VQC members and members of relevant stakeholder groups. The VQC acknowledges the valuable contribution made to this work by the non-VQC members. VQC Patient Transfer Group members Dr Simon Fraser (Chair)* Senior Paediatrician and Chief Medical Ofcer, Latrobe Regional Hospital Dr Robert Grenfell* GP, National Director, Clinical Issues, Heart Foundation Mr Wallace Crellin Consumer representative Dr Emma Mooney Doctors-In-Training, The Australian Medical Association Victoria Mr Dean Jones Director, Inpatient Access, Eastern Health Mr Ian Williams Acting Manager, Non-Emergency Services, Ambulance Victoria Ms Belinda Westlake Health Information, Quality and Risk Manager, Moyne Health Service Ms Lesley Hawes LAOS Statewide Coordinator, General Practice Victoria Ms Tricia Elliot Patient Flow Coordinator, Bendigo Health (*denotes VQC members) GUIDE TO PATIENT TRANSFER 2 Inter-hospital transfers are an important and necessary part of the Victorian healthcare system. Moving patients from one hospital to another is vital to ensure they receive the right care, in the right place at the right time. The Victorian Quality Council developed this guide following feedback from the sector on the need for standardised principles and minimum requirements for nontime critical patient transfer. The guide is informed by: a literature review of current national and international best practice an investmentlogic mapping workshop to defne transfer problems and strategic interventions wide stakeholder consultation through executive directors, directors and managers within the Department of Health, CEOs of public and private health services, Adult Retrieval Victoria, private and public transport providers, quality managers and directors, access managers and the Australian Commission on Safety and Quality in Health Care. The guide includes principles, minimum requirements and an assessment tool for key phases of the transfer process, but it does not attempt to address all the issues for specic transfer settings and patient groups at individual health services. The guide is intended to help executives and senior managers to enhance, develop and implement local policies and procedures for nontime critical inter-hospital patient transfer. The principles, minimum requirements and assessment tool are designed to work together to promote a culture of personal accountability, teamwork and effective communication to ensure patient safety and continuity of care throughout the patient-transfer journey. We anticipate that a culture of safety and continuity of patient care across the delivery system will result in fewer adverse events, higher quality and safer care, and an improved patient experience. Dr Sherene Devanesen Chair Victorian Quality Council P r e f a c e GUIDE TO PATIENT TRANSFER 3 ACKNOWLEDGEMENTS PREFACE INTRODUCTION 4 PURPOSE 5 SCOPE 5 AIM 5 ASSOCIATED RELEVANT LEGISLATION AND POLICIES 5 KEY PRINCIPLES 6 REQUIREMENTS FOR INTER-HOSPITAL PATIENT TRANSFER 7 APPENDICES 11 Appendix 1: Checklist 12 Appendix 2: Assessment tool 13 Appendix 3: Glossary 16 Appendix 4: VQC Inter-Hospital Transfer Patient Transfer Form 18 Appendix 5: VQC Inter-Hospital Transfer Patient Transfer Form instructions for use 20 REFERENCES AND RESOURCES 23
C o n t e n t s 4 Inter-hospital patient transfer is a frequent and important part of the Victorian healthcare system. It falls into two broad groups: time-critical emergency transfers and nontime critical (non-emergency) patient transfers. Patients are transferred between hospitals for numerous reasons, most frequently to access specialised inpatient care not available at the hospital where they are admitted (forward transfer), to return to a hospital from which they were previously transferred (back transfer), and to coordinate resources across health services (Victorian Quality Council 2009). Introduction GUIDE TO PATIENT TRANSFER 5 Inter-hospital patient transfer involves the movement of a patient from one hospital to another; it also involves the transfer of information and professional responsibility and accountability for patient care between individuals and teams within the overall system of care (Victorian Quality Council 2008a). The Victorian Quality Council (2008a; 2008b) has identied many issues with patient transfer processes, including: diffculties with referral and transport processes poor selection of receiving hospitals incomplete documentation of transfer poor or delayed communication (clinical handover) . Poor patient transfer processes are associated with delayed or loss of continuity of care, duplication of services, increased costs and adverse events including patient death (Department of Human Services 2009; Department of Health 2009). To improve the standard of patient transfer, the Victorian Quality Council developed this guide in order to standardise the process across the state, so that all Victorians can receive the high-quality healthcare they need, where and when they need it. Purpose The guide outlines patient-transfer principles and minimum requirements, and includes an assessment tool (see Appendix 2). The purpose of the guide is to help hospital staff: improve local processes and policies for nontime critical inter-hospital patient transfer assess their current patient-transfer systems and processes support the implementation, auditing and enhancement of patient-transfer processes promote a culture of safety and continuity of care throughout the interhospital patient transfer process. Scope These principles and minimum requirements apply to nontime critical patient transfers between hospitals, primarily for admitted patients. While many of the principles and minimum requirements will apply to all patients, hospitals should tailor processes for specic transfer settings, patient groups and their local situation. The document is for all public and private hospital executives and senior managers of clinical teams (medical, nursing, allied health and designated persons) responsible and accountable for planning, developing and implementing policies and procedures for nontime critical inter-hospital patient transfers. Aim The aim of the guide is to standardise patient transfer principles and minimum requirements in order to: strengthen personal accountability, teamwork and effective communication ensure patient safety and continuity of care throughout the patient-transfer journey. Associated relevant legislation and policies This document should be used in conjunction with the following legislation and policies: 1. Australian Commission on Safety and Quality in Health Care (ACSQHC) National Safety and Quality Health Services Standards (NSQHSS), Standard 6: Clinical handover 2. Australian Commission on Safety and Quality in Health Care OSSIE Guide to clinical handover improvement 3. Charter of Human Rights and Responsibilities Act 2006 4. Health privacy principles extracted from the Health Records Act 2001 5. Health Records Act 2001 (Vic) 6. Mental Health Act 1986 (Vic) 7. Safe transport of people with a mental illness. Chief Psychiatrists guideline 2011 7. Non-Emergency Patient Transport Act 2003 8. Non-Emergency Patient Transport Regulations 2005 GUIDE TO PATIENT TRANSFER 6 Key principles The following key principles will support decision making and safe systems to ensure continuity of care during a nontime critical inter-hospital patient transfer. The key principles of patient transfer are: 1. The decision to transfer a patient between hospitals is based on the patients condition and consent, the capability and capacity of the referring hospital to provide the necessary care for the patient, and the receiving hospitals capability and capacity to provide appropriate and safe care. 2. All health professionals involved will ensure that the transfer is timely and that the patient is cared for in such a way as to maintain: patient safety; the necessary treatment and care; contact with appropriate staff; patient dignity; respect for individual needs, including cultural, ethnic and religious needs; patient condentiality; and the safety and wellbeing of the staff involved. 3. All health professionals involved will act in accordance with their accountability and in a collaborative and coordinated manner. 4. The decision to transfer a patient is the responsibility of the attending clinician or designated person at the referring hospital and should involve a senior clinician or designated person. 5. The attending clinician or designated person at the receiving hospital must agree to accept the patient prior to transfer. 6. The receiving hospital will not refuse the patient transfer if it is medically indicated and the receiving hospital has the capability, capacity or responsibility to provide care for the patient. 7. The patient, next of kin or the substitute decision maker (SDM) will provide informed consent for the transfer, and for sharing of information. 8. Clinical handover will occur before the transfer, to ensure all relevant information is exchanged between designated persons at the transferring and receiving hospitals and the transport provider. 9. The attending clinician or designated person at the referring hospital will ensure that copies of all appropriate and pertinent records are transferred with the patient. 10. The attending clinician or designated person at the receiving hospital will ensure that copies of all appropriate and pertinent records have been transferred with the patient. 11. The receiving hospital will, where appropriate and when agreed, ensure the patient is transferred back to the referring hospital in a timely, orderly and safe fashion, with accurate and complete clinical handover. 12. Hospital clinical governance and leadership will implement, audit and enhance transfer processes to ensure a culture of safety and continuity of care. GUIDE TO PATIENT TRANSFER 7 Requirements for inter-hospital patient transfer The following section identies the action steps and minimum requirements for each phase of the transfer process for nontime critical inter-hospital patient transfer. These are a guide only and are not intended to be all-inclusive. It is expected that hospitals will develop their own action steps and minimum requirements for specic transfer settings and patient groups. While a systematic approach to the process of patient transfer is essential, some of the phases and action steps may occur simultaneously when necessary. Requirements for key phases of the inter-hospital patient transfer (IHPT) process for nontime critical patients IHPT phase Action steps Minimum requirements Determine the clinical appropriateness and necessity for patient referral and transfer Assess the patients clinical condition Ensure the necessary and appropriate investigations are carried out Establish if the patient should be transferred, and if an escort is required Identify any likely risks to the patient that may result from, or during, the transfer Ensure that the patient agrees to the transfer and that advance care directives (ACDs) are respected Involve a senior clinician or designated responsible person in the decision to transfer All patients are assessed on admission, and regularly thereafter, to identify and plan for: - appropriate ongoing care and discharge - additional health and social care needs on discharge - referral or inter-hospital transfer as required. Ongoing care occurs in an appropriate place as close to the patients home as possible. The decision to transfer must involve the patient, next of kin or the substitute decision maker (SDM), and a senior experienced clinician or the designated responsible person. The patient has the right to receive treatment and transfer for treatment, or refuse one or both. Each hospital has a documented Patient Medical Assessment Protocol to include speciality-specic criteria for patient referral or transfer. Each hospital has a documented Patient Transfer Policy that identies: - roles and responsibilities of the referring and receiving hospital, the designated persons and transport provider - designated roles that are responsible for the referral or transfer decision and the various steps of the transfer process - the documentation required to accompany the patient. Note: if the patient has advance care directives, or not for resuscitation, limitation of medical treatment or involuntary treatment orders, copies of these documents must accompany the patient so that treatment remains consistent with their terms. All staff must be aware of their roles and responsibilities in relation to patient referral or transfer. All staff undertaking patient transfers should have the appropriate qualications, competencies and training in patient transfer. This includes training in relation to: - patient assessment, monitoring, treatment and evaluation to determine the clinical appropriateness of the transfer and the level of care needed during transfer - responsibilities in relation to patient transfer documentation, referral, delegation, clinical handover and privacy - non-emergency patient transport providers and policies. GUIDE TO PATIENT TRANSFER 8 Requirements for key phases of the inter-hospital patient transfer (IHPT) process for nontime critical patients IHPT phase Action steps Minimum requirements Determine the referral destination and acknowledge acceptance of the referral Determine the appropriate receiving hospital Consult with the receiving team about the referral and bed availability Ensure the referral is accepted by the receiving hospital team Ensure that there is a shared understanding of the purpose (diagnosis, investigation, treatment or second opinion) and expectation of the referral Agree on arrangements for the transfer, arrival, repatriation and feedback Escalate to a senior clinician when: unable to secure an appropriate referral destination; a bed is not available at the receiving hospital within a clinically relevant time, when the transfer is delayed or the patient is deteriorating Ensure that the receiving team names, position title, contact numbers and all issues arising are documented Determining the appropriate receiving hospital will require consideration and assessment of the: - patients current condition and degree of clinical urgency - reason for the transfer to include the intervention required by the patient - capability and capacity of the referring hospital - capability and capacity of the potential receiving hospital - geographical proximity or distance - needs and consent of the patient, next of kin or SDM - established referral relationships or inter-hospital patient transfer agreements. Whenever possible, inter-hospital patient transfer agreements should be in place to facilitate timely transfer of patients. This is especially recommended in locations where patients with complex problems are regularly transferred to a specifc hospital. Inter-hospital transfer agreements where they exist should be documented to enable staff to: - easily contact the relevant service providers - identify role delineation between hospitals and repatriation of patient agreements, which may include transport charging arrangements - identify clinical handover requirements for the receiving hospital, transport provider and the patients GP - identify the appropriate escalation process if: a bed is not available at the receiving hospital; there is a disagreement regarding the transfer or if the patient is deteriorating - identify the designated roles (position titles and contact details) responsible for the transfer decision and the various steps of the transfer process - identify a mechanism for evaluating the transfer process for ongoing quality and safety improvement. Prepare the patient for transfer Involve the patient, next of kin and/or SDM Obtain informed consent for the inter-hospital transfer and consent for sharing patient information with the receiving team, transport provider and the patients GP The patient, next of kin or the SDM is given adequate and timely information about ongoing care, including: the reasons for transfer; the material risks and likely benefts; the procedures involved; expected outcomes; transport options and support available; and the need to share the patients information with the receiving team, transport provider and the patients GP. The information provided is documented in the medical record. The clinician or designated person is responsible for obtaining and documenting the consent to transfer and share patient information. If circumstances do not allow for this then both the indications for transfer and the reason for not obtaining consent is documented in the medical record. The patient, next of kin or SDM is provided admission or transfer information in a format that meets their needs. A copy of the inter-hospital transfer form could be provided to the patient if requested. The interpreter is involved as required The patients vital signs should continue to be monitored regularly to ensure early recognition of clinical deterioration and the need for the transfer to be escalated. GUIDE TO PATIENT TRANSFER 9 Requirements for key phases of the inter-hospital patient transfer (IHPT) process for nontime critical patients IHPT phase Action steps Minimum requirements Coordinate logistics for patient transfer Determine the mode of transport Coordinate the appropriate transport The mode of transport is determined by the referring hospital clinician or designated person in consultation with the receiving hospital clinician or designated person, the patient, and the transport provider. The mode of transport selected will be based on patient acuity, clinical condition, medical needs, legal status under the Mental Health Act 1986, distance or geographical proximity, and availability and timeliness of transport resources. The mode of transport may include public ambulance, private non-emergency patient transport (NEPT), or private or volunteer car transportation. The designated person should ensure the transfer transport is arranged as soon as a date of transfer is known and if possible that the transfer is arranged to take place during business hours. When booking the transport, the designated person should: - be aware of the scope of practice for NEPT providers in relation to patient acuity, and when NEPT is permitted and not permitted for people with mental illness - ensure that the transport provider is informed (where appropriate to meet patient safety needs and respect for patient condentiality) of the patients condition, acuity, weight, pick up time and location, and any special requirements that the patient may have such as IV infusion, interpreter, wheelchair, sight, speech or hearing difculties, or escort requirements. Hospitals should have a documented index of local transport resources to include: - names and contacts details of transport agencies - hours of service - wait time and requirements for booking transport providers - transport options provided by each transport agency along with estimated transit time for transport options - NEPT providers scope of practice - transfer equipment available/required or accommodated. Involve the designated persons and relevant multidisciplinary team members with planning for the transfer of the patient The designated person should ensure that all: - multidisciplinary team members involved in the patient care are notied of the intended transfer to enable planning as a team for the transfer of responsibility and accountability for all aspects of patient care. Ensure the patient is ready for transfer A patient is ready for transfer when: - a clinical decision has been made that the patient is suitable for transfer AND - the receiving hospital has accepted the patient transfer AND - the patient, next of kin or SDM has consented to the transfer and sharing of information AND - all key information on reason for transfer, patient discharge diagnoses, treatment or shared care plans, scheduled follow-up referrals and appointments, medications, investigation results and those pending have been accurately and completely documented and communicated to the receiving hospital, the transport provider and the patients GP AND - all relevant key information, documentation and required medications have been collated to transfer with the patient - the multidisciplinary team has decided the patient is ready for transfer AND - strategies are in place for a safe patient transfer. GUIDE TO PATIENT TRANSFER 10 Requirements for key phases of the inter-hospital patient transfer (IHPT) process for nontime critical patients IHPT phase Action steps Minimum requirements Coordinate clinical handover to: the transport provider the receiving hospital team the patients GP Coordinate clinical handover of the patient, that is the communication (verbal and written) process to transfer professional responsibility and accountability for patient care to the receiving hospital/transport provider Ensure that accurate, complete and appropriate key information is provided to the designated person at the receiving hospital/ transport provider prior to patient transfer Complete documentation and clinical handover Ensure that all key information is transferred with the patient To ensure the transfer of accountability and responsibility for all aspects of patient care, clinical handover should include: preparation for handover using a structured standardised process to ensure that timely, relevant, unambiguous, consistent handover and communication across the whole spectrum of health care providers is achieved nomination of when, how and who will be involved in the handover patient, next of kin or SDM and multidisciplinary team involvement as appropriate the provision of verbal and documented key information on: reason for transfer, patient discharge diagnoses, shared care treatment plans, scheduled follow-up referrals and appointments, medications, investigation results and those pending prior to patient transfer the key information shared should be accurate, complete and appropriate to enable ongoing care and to prevent unnecessary repeat of tests or investigations direct communication, where appropriate from clinician to clinician, clinician to GP, nurse to nurse, nurse to transport provider, allied health to allied health personnel to ensure continuity of patient care and enable the receiver to assume responsibility for patient care use of the patient medical record to facilitate cross-checking of the information documented and handed over. Repatriate the transferred patient Determine repatriation of patient arrangements When a clinical assessment determines that the transferred patient could appropriately be cared for at the original referring hospital and if the patient is stable enough and consents to transfer, the patient should be repatriated. When initiating the inter-hospital patient transfer it is preferable to: - establish the repatriation arrangements,and - the mechanism and timing of follow-up and feedback about the outcome of the transfer from the receiving hospital. Initiate post-transfer follow-up communication with the receiving hospital where appropriate When repatriation is necessary, post transfer communication between the sending and receiving hospital is preferable to enhance : information sharing on the patient outcome shared responsibility for the patient-transfer process the provision of feedback or complaints on the clinical appropriateness of the transfer and the quality of the transfer process collaboration between hospitals. Evaluate the inter-hospital patient transfer process for ongoing quality and safety improvement Establish and maintain a documented process for reviewing nontime critical inter-hospital patient transfer Regularly review inter-hospital patient transfer processes by: - reviewing feedback obtained from patient, next of kin or SDM, receiving hospital, transport providers and GPs - involving the patient, next of kin or SDM and multidisciplinary team in reviews and improvement activities - documenting problems identied and the actions taken to address problems - communicating the actions taken to address problems to all relevant stakeholders - monitoring the volume of inter-hospital patient transfers to enable appropriate allocation of resources. A GUIDE TO USING DATA FOR HEALTH CARE QUALITY IMPROVEMENT 11 11
Appendices GUIDE TO PATIENT TRANSFER 12 Appendix 1: Checklist Determine the clinical appropriateness and necessity for patient referral and transfer Phases Action steps Determine the referral destination and acknowledge acceptance of the referral Prepare the patient for transfer Coordinate logistics for patient transfer Coordinate clinical handover to: the transport provider the receiving hospital team the patient's GP Repatriate the transferred patient Evaluate the inter-hospital patient transfer process for ongoing quality and safety improvement Has the patients clinical condition been assessed? Have the necessary and appropriate investigations been carried out? Does the patient need to be transferred? Does the patient require an escort? Has the likely risks that may result from or during the patient transfer been identified? Has the patient agreed to the transfer and are advance care directives respected? Has a senior clinician or designated person been involved in the decision to transfer? Has the appropriate referral destination or receiving hospital been determined? Has the receiving team acknowledged acceptance of the patient referral? Is there a shared understanding of the purpose and expectation of the referral? Have arrangements for the transfer, arrival, repatriation and feedback been agreed? Is escalation to a senior clinician necessary? Has the receiving team names, position title, contact numbers and issues been documented? Has the patient,next of kin or substitute decision maker been involved in decision making? Has informed consent for the transfer and consent for sharing patient information with the receiving team, transport provider and patient's GP been obtained? Has the appropriate mode of transport been determined and coordinated? Has the designated person and relevant multi-disciplinary team members been involved with planning for the transfer of the patient? Is the patient ready for transfer? Has clinical handover of the patient, (verbal and written communication to transfer professional responsibility and accountability for patient care) to the receiving hospital and transport provider occurred prior to patient transfer? Has documentation of clinical handover occurred? Have copies of all key information and documentation been transferred with the patient? Did the documentation tranferred include a doctor's letter that was cc'd to the GP? When patient repatriation arrangements have been agreed, has post transfer follow-up communication with the receiving hospital been initiated? Has a documented process for reviewing nontime critical inter-hospital patient transfer been established and maintained? Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N
Y/N Y/N
Y/N Y/N Y/N Y/N Y/N GUIDE TO PATIENT TRANSFER 13 Appendix 2: Assessment tool The assessment tool will help executives and senior managers to examine inter-hospital patient transfer processes, and identify priority areas for action to align them with the principles and minimum requirements in this guide. The assessment tool aims to ensure a culture of safety and continuity throughout the patient transfer process. Topic Questions Assessment Yes WIP* No Leadership and patient IHT planning Is there a Patient Transfer Planning Group (PTPG) or equivalent in place with senior executive, clinical, consumer and key stakeholder representation? Does the PTPG or equivalent have terms of reference that clearly dene the members roles, responsibilities and accountabilities? Is there evidence of organisational leadership and governance around implementing, reporting, monitoring and evaluating the patient transfer clinical handover process? Is there an audit process in place to evaluate the inter-hospital transfer processes, incidences, changes or interventions, and lessons learnt? Does the audit process incorporate a peer review of the patient referral or transfer for appropriateness, timeliness, transfer of information and patient satisfaction? Does the audit of inter-hospital transfer include reporting on reason for transfer and volume of transfers by: transfers in and out; hospital or health service; speciality; transport provider (private, NEPT or Ambulance Victoria) and cost? Are audit review recommendations actioned to ensure ongoing quality and safety improvement and to reduce the risk of incidents recurring? Are there systems and processes in place to share lessons learnt from good and poor patient transfer practices, to identify system improvements and encourage a safety culture? GUIDE TO PATIENT TRANSFER 14 Topic Questions Assessment Yes WIP* No Documentation Does the workforce have easy access to a documented Patient Transfer Policy? Was the Patient Transfer Policy developed in partnership with the multidisciplinary team, the patient and next of kin? Is implementation of the Patient Transfer Policy being audited? Is the Patient Transfer Policy reviewed regularly in accordance with the organisations document review cycle? Does the Patient Transfer Policy include: key principles that apply when transferring patient care role and responsibility of the organisation for the provision of clinical governance and leadership of patient transfer systems and processes role and responsibility in relation to implementation and evaluation of patient transfer systems and processes roles and responsibilities of the designated persons responsible for authorising the transfer and the various steps of the transfer process roles and responsibilities in relation to involving the patient, next of kin or SDM in transfer decisions an escalation process in the event of: the patient deteriorating; a bed not being available at the receiving hospital; or if there is a disagreement regarding the transfer specifc transfer requirements for speciality patient groups such as children, mental health patients, renal dialysis patients, et cetera steps taken to initiate a patient transfer to include key phases, action steps and minimum requirements for a nontime critical patient transfer a list of the documentation required to be copied and transferred with the patient to include mandatory documents such as ACD/NFR/limitation of medical treatment order/Mental Health Act paperwork when they exist? inter-hospital transfer agreements, roles and responsibilities, contact details and transport charging arrangements specically where the patient is repatriated a process for accessing potential receiving hospitals an index of local transport resources a process for peer review and feedback on referral management to include review of the appropriateness and timeliness of the referral, transfer of information and patient satisfaction the process for staff to report incidents and near misses relating to patient transfer reference and location of associated policies such as non-emergency patient transport legislation and regulations, clinical practice protocols, Medical Records Act and privacy policies. Communication and coordination of inter-hospital patient transfer Is there a designated role responsible for the coordination and communication of inter-hospital patient transfers? If so, is the role clear to all stakeholdersfor example, is the role published on the hospital website or the hospital capability database? Does the workforce have easy access to a structured clinical handover process for inter-hospital patient transfer that includes: preparation, organisation, verbal and written documentation exchange, timing, environmental awareness and involvement of participants, and patient, next of kin or SDM? Does the workforce have access to a range of tools to support effective inter- hospital transfer clinical handover such as the VQC Inter-Hospital Transfer Form (IHTF) or the Barwon-South Western Quality Advisory Group Transfer Envelope? Is there evidence that the workforce is using the structured process and tools for inter-hospital transfer clinical handover? GUIDE TO PATIENT TRANSFER 15 Topic Questions Assessment Yes WIP* No Patient, next of kin or substitute decision maker involvement Is there evidence that patient, next of kin or SDM is routinely involved in care planning, and consent throughout the transfer process? Is there evidence that patients rights and responsibilities in relation to patient transfer are being complied with; for example, is there evidence that ACDs are transferred with the patient? Is there evidence that clear and accurate information is provided to patients, next of kin or SDM in an appropriate format to meet their needs, for example, a documented consent process? Is patient satisfaction with the patient transfer process monitored? Patient medical assessment Does the workforce have easy access to a documented Patient Medical Assessment Protocol? Does the Patient Medical Assessment Protocol include: specialty-specifc criteria for patient referral and transfer speciality-specifc criteria for clinical escort requirements triggers for referral on to other disciplines or hospitals delegation and responsibility for referral and transfer? Is there evidence that all patients are assessed on admission to ensure that appropriate and timely ongoing care is available? Training and education Is there an education and training program on patient transfer available to clinical staff at orientation? Does the training program include: criteria for patient referral and transfer key phases, action steps and minimum requirements for a nontime critical patient transfer information on NEPT legislation, regulations and clinical practice protocols information on selecting an appropriate receiving hospital? Are arrangements in place for repeat training sessions at regular intervals? Are staff competencies in relation to patient transfer, referral, clinical handover, documentation and patient medical assessment monitored? *WIP: work in progress Name Signature Clinical area Date of assessment GUIDE TO PATIENT TRANSFER 16 Appendix 3: Glossary Term Denition Advance care directive (ACD) An advance care directive (ACD) is a document created by a patient while they are competent, which denes the medical treatment that they wish to refuse should they become incompetent in the dened circumstances. An ACD can record the persons preference for future care and appoint a substitute decision maker to make decisions about healthcare and personal life management. Patients have the right to make decisions about their healthcare, now and for the future. An advance care plan offers the patient an opportunity to say now what life-prolonging medical treatment they would and would not want in the future. Barwon-South Western Region Quality Advisory Group Patient Transfer Envelope The Patient Transfer Envelope was developed by the Barwon-South Western Region Quality Advisory Group. It is an easy-to-use and practical tool for packaging all the relevant documents to be transferred with the patient. It is used only once and is discarded when the patient or resident is admitted. Clinical handover Clinical handover refers to the verbal and written communication process to transfer professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional. Delegation, referral and handover (Medical Board of Australia 2009) Delegation involves you asking another healthcare professional to provide care on your behalf while you retain overall responsibility for the patients care. Referral involves you sending a patient to obtain opinion or treatment from another doctor or healthcare professional. Referral usually involves the transfer (in part) of responsibility for the patients care, usually for a defned time and for a particular purpose, such as care that is outside your area of expertise. Handover is the process of transferring all responsibility to another healthcare professional. Good medical practice involves: taking reasonable steps to ensure that the person to whom you delegate, refer or handover has the qualifcations, experience, knowledge and skills to provide the care required understanding that when you delegate, although you will not be accountable for the decisions and actions of those to whom you delegate, you remain responsible for the overall management of the patient, and for your decision to delegate. always communicating suffcient information about the patient and the treatment they need to enable the continuing care of the patient. Hospital capability The hospitals ability to manage patients requiring specialised medical evaluation and care. Requirements span the range of specialised medical and health services, and may include operating theatres, diagnostic equipment or particular specialist staff. Hospital capacity The hospitals operational ability to manage a volume of patients to include the number of beds available and staffed. Inter-hospital patient transfer Any patient transfer, after initial assessment and stabilisation, from and to another hospital. Non-emergency patient transport Non-emergency patient transport (NEPT) is available for patients who do not require a time-critical ambulance response and who have been assessed by a medical practitioner. NEPT is governed by an Act, regulations and clinical practice protocols. The Department of Health is responsible for the development and implementation of: Non-Emergency Patient Transport Act 2003 Non-Emergency Patient Transport Regulations 2005 Non-emergency patient transport: clinical practice protocols. GUIDE TO PATIENT TRANSFER 17 Term Denition Not for resuscitation (NFR) Not for resuscitation (NFR) is an order to prevent the use of cardiopulmonary resuscitation (CPR) in situations where the patients heart stop or the patient stops breathing. The NFR order is made when CPR is deemed medically futile or unwanted by the patient. An NFR order is documented in a form which may be referred to as a Limitation of Medical Treatment Form. Nontime critical patient transfer: (non-emergency patient) -versus- Time-critical patient transfer (emergency patient) Nontime critical patient transfer occurs when a stabilised patient needs to be transferred, either forward to a higher level of care or back to a lower level of care or closer to home, and the attending clinician or designated person has determined that: the patient transfer is not urgent and that the patient is stable to transfer the patient is unlikely to require transfer or transport under emergency conditions irrespective of their acuity (high, medium or low). The nontime critical patient is also referred to as a non-emergency patient. Time-critical patient transfer occurs when a patient requires emergency care at the closest appropriate hospital in the shortest time possible to achieve early intervention and stabilisation. This patient will require transfer and transport under emergency conditions. The time-critical patient is also referred to as an emergency patient. Receiving hospital A hospital to which a patient is transferred for treatment, ongoing care or investigations. Referring hospital A hospital from which a patient needs to be transferred, that is, the hospital that identies the need for and initiates the patient transfer. Substitute decision maker A substitute decision maker (SDM) is appointed or identied by law to make substitute decisions on behalf of a person whose decision-making capacity is impaired. Types of inter-hospital transfers Forward transfer: a transfer to a higher level of care than that available at the referring hospital, for treatment such as inpatient specialist treatment. Back transfer: a transfer back to a lower level of service, usually following completion of an episode of care, or return transfer (repatriation) of an inpatient to the primary hospital, or transfer of a patient to another hospital for recovery. Lateral transfer: a transfer to a hospital with the same level of care. This may occur when the referring hospital facilities are unavailable. Transfer for investigations: a transfer for investigations not available at the referring hospital. The patient is usually transferred back to the referring hospital once the results have been discussed with the doctor. Victorian Quality Council (VQC) The Victorian Quality Council (VQC) is a ministerial advisory council that was established in 2001. The VQC is responsible for fostering better quality health services in Victoria by working with stakeholders to develop useful tools and strategies to improve health service safety and quality. VQC Patient Transfer Group (PTG) The VQC Patient Transfer Group was established in 2009 to improve and standardise inter-hospital patient transfer processes. VQC Inter-Hospital Transfer Form (IHTF) The VQC Patient Transfer Group developed and piloted a generic Inter-Hospital Transfer Form (IHTF) for nontime critical patients. The IHTF has been endorsed by the Secretary for Health and the full VQC for implementation across all Victorian health services from January 2012.
GUIDE TO PATIENT TRANSFER 18 Appendix 4: VQC Inter-Hospital Transfer Patient Transfer Form
Place Health Service Logo Here Transfer discussed with patient Yes No Date of transfer Indigenous status (circle) A / TSI ATSI / Unknown
Medicare no. ________________________
Pension / DVA no. ___________________ Private health insurance (PHI) fund ___________________________ PHI no. (Affix patient label here) Referring facility URN Surname Given names Address Postcode DOB Gender Male Female Allergies Nil known Yes (if yes list type, reaction and severity) Signature General practitioner Yes No Unknown GP name__________________________ GP phone no. ______________________ GP notified of transfer Yes No Unknown Next of kin (NOK) / Carer / Substitute decision maker (SDM) (Circle) Name _________________________________ Phone no. ______________________________ Relationship to patient________________________ NOK / Carer / SDM notified of transfer Yes No I d e n t i f y Referring / authorising practitioner name ________________________________ Referring unit _______________________ Referrer phone/pager no. _________________ Referrer position (Consult / Reg / HMO / GP / RN / Other) Referring ward Name _____________________ Phone no.___________________ Patient living arrangements
Living independently
Residential facility
In-home support Principal diagnosis / problem
Reason for transfer Medical history / comorbidities
Observations at time of transfer: T_____.P_____ B/P _____ Respiratory management plan / O2 requirements Sp02 target O2 rate O2 device* *If ETT record any difficulty with intubation. Intravascular access Site and date of insertion No access Peripheral venous line (1) ... Peripheral venous line (2) ... Peripheral venous line (3) ... Central venous line . Other . IV fluids Yes No Mental / cognitive / behaviour No issues Cognitive impairment Post-traumatic amnesia Verbal aggression Delirium Physical aggression Sleep disturbance Resistive to care Dementia Absconding risk Depression Wanderer Acquired brain injury Harm to self Harm to others Other _________________________ Current cognitive state ________________ Glasgow Coma score Continence No issues Faecal continence Urinary continence Indwelling catheter Intermittent catheter Stoma / colostomy Time last voided Date bowels last opened Date IDC inserted S i t u a t i o n Legal status Not applicable Voluntary patient Involuntary patient Forensic patient Security patient Nutrition and swallowing Fasting: Yes No Time of last intake________ Diet: Normal Diabetic Renal Soft Puree Minced NBM Fluids__________________ Supplements ______________ Restrictions _______________ Safe swallow strategies:________ Medication Crushed Whole Enteral feeding NG PEG Regime and feed sent Yes No Dentures Yes No Weight Communication Interpreter required No Yes Primary language spoken Patient transfer form (inter-hospital) Nontime critical patients Facility name
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D a t e N u m b e r & D e s i g GUIDE TO PATIENT TRANSFER 19
Patient transfer form Facility name Date Page 2 (Affix patient label here) Referring facility URN Surname Given names Address Postcode DOB Gender Male Female B a c k g r o u n d
Specialty-specific information Alerts none _____________________ Alerts bariatric patient _____________________ Alerts falls risk _____________________ Alerts infectious risk _____________________ Alerts pressure ulcer risk _____________________ Alerts smoker _____________________ Advance care directives Yes No Unknown NFR / limitation of medical treatment order Yes No Unknown Alerts other: A c c o m p a n y i n g
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Personal Accompanying Sent with items N/A patient family Clothing Glasses Dentures Hearing aid Medications Equipment __________________ _ _ Valuables List valuables_____________________________________ ___________________________________________ ___ Other If an air-ambulance transfer, luggage has to be less than 5 kgs Patient ID band on patient Yes Attached copy of documentation: ( where applicable ) Doctors letter Cognitive assessment tool Allied health letter *Advance care directives Observation chart Nursing care plan / pathway Medications chart Fluid balance chart IV orders Behaviour management plan Wound chart *Involuntary treatment order *NFR / limitation of medical treatment order Investigation results: X-rays ECG Pathology report Other * Where these exist, a copy must accompany the patient Receiving facility (RF) Appropriate time for transfer agreed Yes No RF name RF ward name Acceptance by receiving medical practitioner Yes No Date Time Receiving medical practitioner / unit name _____________________________ Receiving practitioner / unit phone no. and pager Acceptance by receiving facility bed coordinator Yes No Date Time Receiving bed coordinator name _________________________________________ Receiving bed coordinator phone no. and pager Treating allied health contact details (if applicable) Discipline Name Pager/phone Discipline Name Pager/phone Occupational therapist Dietitian Physiotherapist Social worker
Speech pathologist Other Form completed by (print name and job designation ) : Signature: Patient transport provider (TP) service name _____________________ Date and time booked Handover received Yes No Accompanying documentation received Yes No Receiving transport provider name (print) Signature R e s p o n s i b i l i t y
Handover provided: by referring staff Yes No : by TP Yes No . Accompanying documentation provided Yes No Accompanying items checked Yes No
Receiving clinical staff name (print) Signature Fax the form to receiving hospital prior to patient transfer. A copy should accompany the patient and the original form should be filed in the patient medical record. P a t i e n t
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f o r m GUIDE TO PATIENT TRANSFER 20 Appendix 5: VQC Inter-Hospital Transfer Patient Transfer Form instructions for use
VQC inter-hospital patient transfer form Instructions for use
The Victorian Quality Council The Victorian Quality Council The Victorian Quality Council The Victorian Quality Council Safer, better healthcare for all Victorians www.health.vic.gov.au/qualitycouncil www.health.vic.gov.au/qualitycouncil www.health.vic.gov.au/qualitycouncil www.health.vic.gov.au/qualitycouncil December 2012
Introduction Introduction Introduction Introduction The Victorian Quality Council (VQC) inter-hospital transfer form aims to improve standardisation of clinical handover and documentation for nontime critical inter-hospital patient transfers. The Department of Healths Secretary and the VQC endorsed the implementation of the form by all Victorian health services from January 2012. The form will help to: ensure pertinent and accurate patient information is exchanged between the referring and receiving facility and the transport provider standardise the terminology and the minimum data sent and expected by health services during patient transfer reinforce the need to transfer professional responsibility and accountability by identifying key responsible people at the sending and receiving hospitals and the transport provider service replace the multitude of transfer forms with varying information currently being used by Victorian health services complement the Guide to patient transfer: principles and minimum requirements.
T TT Typ yp yp ype ee es ss s of of of of patient t patient t patient t patient transfers ransfers ransfers ransfers covered covered covered covered The form is is is is intended for use in nontime critical transfers involving: adult inter-hospital transfers transfers between acute health services transfers provided by both private and public transport providers.
The form is no is no is no is not tt t intended for use in transfers involving: time-critical patients specialist patient transport services such as Adult Retrieval Victoria, trauma retrievals, Newborn Emergency Transport Service (NETS), Victorian Paediatric Transport Service (PETS) and Perinatal Emergency Referral Service (PERS).
The form may may may may be used in transfers involving: inter-campus transfers, such as between hospitals in a health service hospitals and other facilities, such as between hospitals and rehabilitation centres, aged care facilities or GP surgeries. However, you may need to modify the form for inter-campus, rehabilitation or aged care transfers (see Appendix 1). Transfer process Transfer process Transfer process Transfer process Confirm that the patient is to be transferred. Identify if the patient fulfils the criteria for the intended use of the form. Complete the form. All sections must be completed. A copy of the form should be faxed to the receiving hospital prior to patient transfer, a copy should accompany the patient during transfer and the original form should be filed in the patient medical record. Local Local Local Local modifications modifications modifications modifications to the to the to the to the f ff form orm orm orm The dataset contained in the VQC form is the minimum data that all hospitals should provide and receive when undertaking a patient transfer. This dataset or its location under the sections should not be changed. Modification may be made to form, such as inserting your health service name, logo and a medical record number, formatting to comply with the Australian Standard 2828 for paper-based healthcare records or adding to the specialty- specific area if required. If you wish to use the form for all transfers including aged care and inter-campus transfer, we have included suggestions for consideration in Appendix 1. An electronic copy of the form is available at: http://www.health.vic.gov.au/qualitycouncil
GUIDE TO PATIENT TRANSFER 21 VQC inter-hospital patient transfer form Instructions for use
The Victorian Quality Council The Victorian Quality Council The Victorian Quality Council The Victorian Quality Council Safer, better healthcare for all Victorians www.health.vic.gov.au/qualitycouncil www.health.vic.gov.au/qualitycouncil www.health.vic.gov.au/qualitycouncil www.health.vic.gov.au/qualitycouncil
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Referring facility URN: Referring facility URN: Referring facility URN: Referring facility URN: t tt the patients unique record number (URN) at the referring facility. Indigenous Indigenous Indigenous Indigenous status status status status: : : : an Aboriginal or Torres Strait Islander person is defined as a person of Aboriginal (A) (A) (A) (A) or Torres Strait Islander (TSI) (TSI) (TSI) (TSI) descent, who identifies as being A AA A or TSI TSI TSI TSI. Information on indigenous status is collected by asking Are you of Aboriginal or Torres Strait Islander origin? and the response is recorded by circling either: A or TSI; or Aboriginal and Torres Strait Islander (ATSI); or unknown. Allergies Allergies Allergies Allergies: : : : if allergies are known, list the allergen type, reaction and severity. Allergen types may include medications, foods, inhalants, environmental substances, latex and other. Substitute Substitute Substitute Substitute decision maker decision maker decision maker decision maker (SDM): (SDM): (SDM): (SDM): an SDM may be appointed by the person, appointed for (on behalf of) the person or identified as a substitute decision maker under the Guardianship and Administration Act 1986. S i t u a t i o n
S i t u a t i o n
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The situation section should include a comprehensive overview of admission diagnosis, relevant medical history, the reason for transfer, observations at time of transfer, respiratory treatment requirements and information on nutrition and continence, if applicable. SpO SpO SpO SpO2 2 2 2 target target target target: :: : refers to the acceptable patient oxygen saturation range when measured by a pulse oximeter. ETT ETT ETT ETT : : : : refers to an endotracheal tube or breathing tube. Please note that any difficulty with intubation will need to be recorded on the form and communicated during handover to the receiving hospital/facility Forensic Forensic Forensic Forensic patient patient patient patient: :: : refers to a patient who is remanded, committed or detained in custody in an approved mental health service by a supervision order under the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997. Security Security Security Security patient patient patient patient: : : : refers to a patient who is a prisoner detained in custody in an approved mental health service under s. 16 or 16A of the Mental Health Act 1986. Involuntary Involuntary Involuntary Involuntary patient patient patient patient: :: : refers to a patient who is subject to an involuntary treatment order under s. 12 or 12AA of the Mental Health Act 1986. Principal Principal Principal Principal diagnosis diagnosis diagnosis diagnosis: :: : refers to the condition that is established after investigation and responsible for the patients admission to hospital. Past Past Past Past medical medical medical medical history history history history / // / c cc comorbidities omorbidities omorbidities omorbidities: :: : refer to significant medical events, for example obesity and comorbidities of hyperlipidemia, hypertension and type 2 diabetes. B a c k g r o u n d
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The background section should include: a aa a specialty specialty specialty specialty- -- -specific specific specific specific area area area area that allows for the addition of specialty-specific information, such as dialysis indication, commencement date, centre, type, frequency and schedule along with dialysis access type alerts alerts alerts alerts refer to known at-risk alerts. . . . Tick known alerts, or tick none. A c c o m p a n y i n g
A c c o m p a n y i n g
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The accompanying section may be used as a checklist to remind you of the documentation that should accompany the patient and personal items that may accompany the patient or be sent with the family. Personal Personal Personal Personal luggage luggage luggage luggage: : : : if the patient is an air-ambulance transfer, luggage has to be less than five kilograms. Documentation: Documentation: Documentation: Documentation: where an advance care directive, involuntary treatment order or not for resuscitation/limitation of medical treatment order exists, a copy must accompany the patient. R e s p o n s i b i l i t y
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The responsibility section reinforces the need for the receiving clinician or designated person to accept the patient prior to transfer and the need to transfer professional responsibility and accountability by identifying key responsible people at the sending and receiving hospitals and the transport provider service. The responsibility section requires documentation to include: the receiving facility/ward name, medical practitioner, bed coordinator/designated person, treating allied health contact details, and your name, job designation and signature the transport provider (if applicable ) to acknowledge receipt of a handover and documentation (please note- transport providers do not accept responsibility for accompanying non-medical personal items ) the receiving clinical staff member to acknowledge receipt of a handover, accompanying personal items and documentation. Handover should be provided by the designated person at the referring facility prior to patient transfer and by the transport provider (if applicable) at the time of transfer. Implementing the form Implementing the form Implementing the form Implementing the form Some recommendations for implementing the form include: identify key staff on each unit to support, monitor and manage the implementation of the form update the executive team regularly about the progress of the implementation so they can provide constructive advice and support strategies for overcoming barriers identify key staff involved in the transfer process, such as nurse unit managers, discharge coordinators, access managers, ward clerks and transport operators, and consult with them prior to its implementation so that they can offer support and assistance. GUIDE TO PATIENT TRANSFER 22 VQC inter-hospital patient transfer form Instructions for use
The Victorian Quality Council The Victorian Quality Council The Victorian Quality Council The Victorian Quality Council Safer, better healthcare for all Victorians www.health.vic.gov.au/qualitycouncil www.health.vic.gov.au/qualitycouncil www.health.vic.gov.au/qualitycouncil www.health.vic.gov.au/qualitycouncil
Appendix Appendix Appendix Appendix 1 11 1 Suggestions for Suggestions for Suggestions for Suggestions for modifications modifications modifications modifications to the to the to the to the form form form form Some health services may wish to use the form for all transfers including aged care and inter-campus transfer. We have included the following suggestions that may be added to the minimum dataset in the VQC form. Neurological Neurological Neurological Neurological ( if applicable) Conscious state: Conscious state: Conscious state: Conscious state: alert drowsy varies Mood Mood Mood Mood: normal agitated flat Memory: Memory: Memory: Memory: normal short-term problems confused state MMSE MMSE MMSE MMSE. Triggers: Triggers: Triggers: Triggers: .. Intervention strategies: Intervention strategies: Intervention strategies: Intervention strategies: .... Mobility/ Mobility/ Mobility/ Mobility/transfers transfers transfers transfers/ // /physical f physical f physical f physical function unction unction unction ( if applicable) Mobility: Mobility: Mobility: Mobility: Independent Chair/bed bound Requires assistance no. of staff required Bed mobility: turns sits Weight-bearing status: none left right partial left right full left right Ambulation. Endurance. Aids Aids Aids Aids used used used used: : : : Walking stick/s Frame Wheelchair Prostheses .. Transfers: Transfers: Transfers: Transfers: Independent Requires assistance no. of staff required Aids Aids Aids Aids used used used used: :: : Slide sheet Lifter type................... Other transfer aids type .................... Falls Falls Falls Falls risk risk risk risk ( (( (FR): FR): FR): FR): FR score Needs bed rails Other Other Other Other safety requirements safety requirements safety requirements safety requirements: : : : Personal Personal Personal Personal care care care care ( mark: A AA A = assistance needed; I II I = independent; D DD D = dependent; S SS S = supervision) Bathing: Toileting: Dressing: Eating: Skin Skin Skin Skin i ii integrity and ntegrity and ntegrity and ntegrity and wounds wounds wounds wounds ( if applicable) Pressure areas: Braden score: Site(s): .. Appearance: Stage: Dressing: . Pressure mattress: Type: .... Other wounds: Describe: ...... Sutures/staples: Date to be removed: Communication/ Communication/ Communication/ Communication/sensory sensory sensory sensory ( if applicable) Communication: Communication: Communication: Communication: Normal Follows directions Responds to non-verbals Speech: Speech: Speech: Speech: Normal Impaired Aphasia: expressive receptive Sign language use Vision: Vision: Vision: Vision: Normal Impaired Blind Artificial eye/s: right left Glasses Hearing: Hearing: Hearing: Hearing: Normal Impaired Deaf Aid/s: right left Long Long Long Long- -- -term plan term plan term plan term plan ( if applicable) Yet to be determined Home independently / services / carer Respite care Hospice Supported residential service Residential care: high-level (nursing home) Residential care: low-level (hostel)
Transitional care program: home based Transitional care program: residential Other: Enduring Enduring Enduring Enduring power power power power of of of of attorney attorney attorney attorney / // / administrator administrator administrator administrator/ / / / guardianship guardianship guardianship guardianship / / / / substitute decision maker substitute decision maker substitute decision maker substitute decision maker (SDM) (SDM) (SDM) (SDM) ( if applicable) No Required Pending Yes Name and contact details:
A GUIDE TO USING DATA FOR HEALTH CARE QUALITY IMPROVEMENT 23 23 References and Resources GUIDE TO PATIENT TRANSFER 24 References Department of Health 2009, Limited adverse occurrence screening (LAOS): annual report 200809, State Government of Victoria, Melbourne. Department of Human Services 2009, Sentinel event program annual reports, State Government of Victoria, Melbourne, http://www.health.vic.gov.au/clinrisk/sentinel/ser.htm Medical Board of Australia 2009, Good medical practice: a code of conduct for doctors in Australia, Medical Borad of Australia, http://www.medicalboard.gov.au/Codes- Guidelines-Policies.aspx Victorian Quality Council 2009, Inter-hospital patient transfer: a thematic analysis of the literature, State Government of Victoria, Melbourne, http://www.health.vic.gov.au/qualitycouncil/ downloads/interhospital_pt_litreview.pdf Victorian Quality Council 2008a, Current inter-hospital patient transfer practice, State Government of Victoria, Melbourne, http://www.health.vic.gov.au/qualitycouncil/ downloads/current_ihpt_surveyrpt.pdf Victorian Quality Council 2008b, Themes from the Victorian Quality Council Inter-hospital Patient Transfer Workshop: group work summary, State Government of Victoria, Melbourne. Resources Australian Charter of Healthcare Rights, http://www.safetyandquality.gov.au/internet/safety/ publishing.nsf/Content/PriorityProgram-01 Charter of Human Rights and Responsibilities Act 2006 http://www.legislation.vic.gov.au Safe transport of people with a mental illness. Chief Psychiatrists guideline. http://www.health.vic.gov.au/mentalhealth/cpg/ safetransport.pdf Clinical handover resources Australian Commission on Safety and Quality in Health Care, National Safety and Quality Health Services Standards http://117.53.168.228/implementation-toolkit- resource-portal/interface/additional-clinical-handover- resources/acsqhc-resources-and-publications.html New South Wales Department of Health, Australian Resource Centre for Health Innovations http://www.archi.net.au/resources/safety/clinical/ nsw-handover South Australia Department of Health, Safety and Quality http://www.sahealth.sa.gov.au/wps/wcm/connect/ Public+Content/SA+Health+Internet/About+us/ Safety+and+quality/Communications+and+teamwork/ Communication+and+teamwork Western Australia Department of Health, Ofce of Safety and Quality in Health Care http://www.safetyandquality.health.wa.gov.au/ initiatives/clinical_handover.cfm Queensland Department of Health, Patient Safety and Quality Improvement Service http://www.health.qld.gov.au/psq/handover/html/ ch_homepage.asp Australian Medical Association 2006, Safe handover, safe patients: guidance in clinical handover for clinicians and managers, AMA, Canberra. http://www.ama.com.au/node/4064 Victorian Quality Council handover resources http://www.health.vic.gov.au/qualitycouncil/activities/ handover.htm Legislation Health Records Act 2001 (Vic) http://www.legislation.vic.gov.au Health Records Act: frequently asked questions http://www.health.vic.gov.au/hsc/resources/faq.htm Health Records Act: online training http://www.health.vic.gov.au/hsc/training.htm Health privacy principles, extracted from the Health Records Act http://www.health.vic.gov.au/hsc/downloads/ hppextract.pdf Mental Health Act 1986 (Vic) http://www.legislation.vic.gov.au Non-Emergency Patient Transport (NEPT) Act 2003, regulations 2005 http://www.health.vic.gov.au/nept/nept-rcpp.htm Guidetopatienttransfer Principlesandminimumrequirements fornon-timecriticalinter-hospital patienttransfer RevisedDecember2012