The American College of Surgeons requires that referring hospitals provide feedback to prehospital providers and referring hospitals regarding the transfer process.

Failure to do so can actually result in an opportunity for improvement or deficiency during a site visit. (Psst! Pay attention, referring hospitals if you want to start getting feedback. Read that first sentence again. See standard 7.10.) Sometimes the feedback is verbal, either in person or by phone. Many receiving centers send written letters outlining care and care issues. But unfortunately, some don’t do it at all, or only very inconsistently.

Harborview Hospital in Seattle is a very busy Level I center, with nearly 6,000 trauma admissions per year. More than half of their patients come from a vast catchment area that includes Washington state, Wyoming, Alaska, Idaho, and Montana. Providing proper feedback on over 3,000 patients annually can be overwhelming, given the amount of work required.

They implemented a “U-link” program that provided access to patient chart info for the hospital sending each patient. It was HIPAA compliant, and login information was sent within 72 hours of patient arrival.

Here are the factoids:

• 90 referring hospitals set up the U-link system
• Care transcripts, radiology reports, and discharge summaries were the most frequently viewed items
• The most desired feedback was on over- or under-resuscitation (89%), injuries (84%), appropriateness of transfer (78%), and deviation from ATLS protocols (76%)
• Information was used for education (100%), systems analysis (99%), and performance improvement (PI, 92%)

Bottom line: Your referral partners crave feedback on the patients they send! Develop a system that guarantees it for each patient at a reasonable time after admission. You may or may not be able to link them into your specific electronic medical record, but you can certainly send out informational letters and emails!

Reference: Optimizing feedback from a designated Level I trauma/burn center to referring hospitals. JACS 220(1):99-104, 2015.