Improving patient handovers: implementation of the Transfer Intervention Procedure (TIP)

This study is set to implement the Transfer Intervention Procedure (TIP); a discharge bundle to improve discharge care on an organizational level. We aim for a one hundred percent of medical, medication and nursing handovers being sent within 24 hours to the next health care provider. Yet at the same time, professionals should be aware that this does not come at the expense of the content of the patient handovers. To our knowledge this is the first study that investigates the implementation of such a discharge bundle on a large, national-scale, in eight different Dutch hospitals: Haven hospital Rotterdam; Maxima Medical Center Veldhoven; Lange Land Hospital Zoetermeer, OLVG Amsterdam; Gelre Hospitals Apeldoorn; Catharina Hospital Eindhoven; Reinier de Graaf Hospital Delft and the Academic Medical Center, University of Amsterdam. If effective, nationwide implementation of the discharge bundle may result from this study protocol.

We aim to investigate the effect of a comprehensive discharge bundle, the Transfer Intervention Procedure (TIP), on the time between discharge and the time when the medical, medication and nursing handovers are sent to the next health care provider. Our goal is to reduce this time to 24 hours after hospital discharge. Secondary outcomes are length of hospital stay and unplanned readmission within 30 days rates

An interrupted time-series (ITS) study will be conducted from March 2016 until June 2017. There will be six pre-implementation measurements and six post-implementation measurements with one-month intervals. During the transition period, i.e. two months, implementation activities are set up and no measurements will be conducted.

The Transfer Intervention Procedure (TIP), which provides the foundation for a safe and reliable discharge process.
The TIP discharge bundle consists of four elements: 1) determining the discharge date within 48 hours after admission and communication of the discharge date with the patient, 2) start with arrangement of required post-discharge care within 48 hours after admission, 3) set up patient handover (medical, medication, nurse) and personalized patient discharge letter (PPDL) within 48 hours after admission, 4) plan a discharge conversation with the patient to explain information from the PPDL 12 to 24 hours before discharge.