Improving Inter-Hospital Transfer Documentation Through Standardisation and Accountability: A Quality Improvement Study in a Resource-Limited Sri Lankan Hospital

Abstract : Background: Incomplete transfer documentation contributes to communication failures, delayed clinical decision-making, and increased patient safety risks during inter-hospital transfers. These risks are amplified in resource-limited settings due to system inefficiencies, high workload, and lack of standardisation.¹–³ Objective: To improve the completeness, accuracy, and accountability of inter-hospital transfer documentation through structured system-level interventions. Methods: A single-centre quality improvement study using Plan–Do–Study–Act (PDSA) cycles was conducted at Base Hospital Kinniya, Sri Lanka from January to June 2019 for a period of 6 months. A retrospective audit of 436 inter-hospital transfer forms was conducted using predefined criteria derived from Ministry of Health standards and stakeholder consensus. Two PDSA cycles were implemented: the first introduced staff training and a structured documentation seal; the second introduced a “probable diagnosis” field and a checking officer system. Key indicators included documentation of diagnosis, reason for transfer, vital signs, treatment given, and time of transfer. Descriptive statistics were used to analyse changes in documentation completeness. Results: Baseline assessment demonstrated major deficiencies in documentation, including diagnosis (61.5%), treatment given (42.2%), time of transfer (14.7%), and oxygen saturation (26.6%). Following PDSA cycle 1, improvements were observed across all parameters. After PDSA cycle 2, near-complete compliance was achieved in most domains, including diagnosis (99.1%), heart rate (100%), blood pressure (100%), and time of transfer (98.6%). Treatment documentation improved to 94.9%, and oxygen saturation to 98.6%. Documentation verification reached 100% following introduction of a checking officer. Conclusion: System-level interventions incorporating standardisation, training, and accountability significantly improved transfer documentation completeness. This low-cost, scalable approach is potentially applicable to similar resource-limited healthcare settings.