Exploring Communication Gaps in Multidrug-Resistant Organism Interfacility Patient Transfers: Insights from Paulina M. Colombo's Participation in the NSF I-Corps Social Innovation Program

Abstract:

The NSF I-Corps Social Innovation Program, hosted by Tech Launch Arizona, allowed Paulina M. Colombo, a PhD Epidemiology student, to explore communication practices during interfacility transfers (IFT) of patients with multidrug-resistant organisms (MDROs) in Spring 2024. Through semi-structured interviews with healthcare professionals, Paulina identified significant gaps in communication, particularly the lack of standardization, which often led to delays in transmitting infection-related data during patient transfers. Participants noted that these delays were worsened by resource constraints, such as inadequate staffing and limited access to technological tools like electronic health records. These findings highlight the need for standardized communication protocols and digital tools, which will inform Paulina’s dissertation on the role of IFT in MDRO transmission.

Introduction

The National Science Foundation (NSF) I-Corps Social Innovation Program, hosted by The University of Arizona’s Tech Launch Arizona, offers a platform for provides a platform for early-stage entrepreneurs and researchers to test their ideas, particularly in the realm of social impact. During the Spring 2024 cohort, I participated in the program to informally explore the communication practices surrounding interfacility transfers (IFT) of patients with multidrug-resistant organisms (MDROs). This preliminary research was aimed at identifying gaps in communication during these transfers and understanding how such gaps may contribute to MDRO transmission. The findings from this inquiry will inform future formal research, including my dissertation, which will focus on the role of IFT in MDRO transmission. 

Methods

I conducted a series of semi-structured interviews with professionals involved in infection prevention and healthcare management. The interviews were designed to capture insights into communication practices during MDRO patient transfers and were conducted predominantly through Zoom to accommodate participants from various locations. A REDCap project was developed to facilitate the organization, data collection, and secure storage of the information gathered during the interviews. The interviews explored participants' experiences with communication protocols, barriers to effective data transfer during patient transitions, and potential improvements to reduce MDRO transmission.

Results

A total of 20 participants were interviewed over the course of the project. These individuals represented a variety of roles within the healthcare system, including infection preventionists, healthcare administrators, and regulatory officials. Participants were drawn from a diverse array of healthcare settings, including acute care hospitals, long-term care facilities (LTCF), and regulatory entities such as Arizona health departments and the Centers for Disease Control and Prevention. The diversity of participants provided a broad perspective on the communication challenges faced by different types of institutions during MDRO patient transfers.

Key findings from the interviews revealed several critical issues in the communication of MDRO patient status during interfacility transfers. A prominent theme was the significant lack of standardization in the communication protocols employed by different healthcare facilities. Participants frequently cited wide variations in how MDRO patient information was documented, communicated, and received, which often led to delays in the transfer of essential infection-related data. These delays, according to interviewees, could last hours to days, during which time receiving facilities might not have the necessary infection control measures in place. 

The communication breakdowns occurred most often when patients were transferred between acute care hospitals and LTCF. Acute care hospitals generally had more structured protocols for reporting infection status, but these protocols were not always aligned with those used by LTCF. This misalignment often resulted in incomplete or inconsistent transmission of information, such as the patient’s MDRO history, current infection status, and required precautions, which could compromise infection control efforts and patient outcomes.

Additionally, many participants emphasized that resource constraints posed a significant challenge to effective communication. In particular, inadequate staffing, particularly among infection preventionists, was a common issue that was especially pronounced among lower resourced settings, such as LTCF. Many facilities lacked the personnel needed to ensure timely and accurate communication of MDRO patient status. Limited access to advanced technological tools further hindered efforts to streamline communication. For example, facilities without integrated electronic health record (EHR) systems often relied on manual, time-consuming methods like fax or phone calls, increasing the risk of errors and missed information.

Despite these challenges, interviewees identified clear opportunities for improvement. A major recommendation was the adoption of standardized digital communication tools, such as infection control modules integrated into EHR systems, which could automate the transmission of MDRO status and other critical information during patient transfers. Some participants also suggested creating regional or statewide databases to centralize MDRO patient data, allowing facilities to quickly access up-to-date infection information before a transfer occurs. Standardizing communication protocols and improving access to digital tools were seen as essential steps to improve infection control and reduce the spread of MDROs during interfacility transfers.

Discussion

The findings from these interviews highlight the need for standardized communication protocols during MDRO patient transfers to reduce the risk of infection spread. The current variability and fragmentation in communication practices represent significant risks for the transmission of MDROs. Moving forward, a formal qualitative study should be conducted to further investigate these communication gaps. Additionally, the development of a network of infection preventionists, which was initiated during these interviews, will be crucial for future studies and interventions aimed at improving communication practices and infection control. These initial insights will serve as a foundation for my dissertation, which will explore how IFT contributes to MDRO transmission and develop recommendations for improving communication and containment practices across healthcare facilities.