The Aged Care Home Transfer-to-Hospital Envelope (the Envelope) was developed as part of the North East Valley Division of General Practice's (NEVDGP) Aged Care GP Panels Initiative program. NEVDGP was one of 14 organisations across Australia chosen by the Australian Commission on Safety Quality in Health Care (the Commission) to improve the safety of patients by improving 'clinical handover' communication.

The one year project from September 2007 to October 2008 led by NEVDGP trialled the use and usefulness of the Envelope as a tool to support safe clinical handover when an aged care home resident is transferred to a hospital Emergency Department.

The Envelope is a big, bright yellow resealable envelope in which to put a resident's medical documents and other key information to 'go with' a resident of an aged care home when the resident is transferred to hospital. As well as functioning as a container for documents, the Envelope features a checklist of key clinical and other handover information needed when a resident is transferred to hospital.

A template of the Envelope, which can be printed directly onto a C4 size envelope or sent to a commercial printer is freely available from:

•  Primary Care Support, Aged Care Initiative page of the NEVDGP website. Select "Transfer to Hospital Envelope".
•  Transfer-to-Hospital Envelope page of the Australian Commission on Safety and Quality in Health Care website.

The Envelope is also available for purchase from  Compact Business Systems, Ph 1800 777 508 or email: sales@compact.com.au

The Transfer-to-Hospital Envelope is a stand-alone tool with simple, clear instructions needing little implementation support or training to be used effectively, and envelopes in general are age-old communication tools that everyone is familiar with. However, a Standard Operating Procedure (SOP) tool for use of the Envelope has been developed which may be of some value in settings where the Envelope has not previously been used. This tool is also available on the NEVDGP and Commission's websites.

Features of the Envelope are:

• A container for clinical and other handover information.
• A tick box checklist for aged care home staff on the back on the Envelope to readily identify clinical and other handover information required when transferring a resident hospital.
• The tick box checklist facilitates standardised content of clinical and other handover information going to hospital.
• The Envelope flags the patient in the Emergency Department as a resident of an aged care home.
• It informs hospital staff of the level of care of the aged care home the resident has come from and will return to.
• It provides a brief description for hospital staff of the range of levels of care in aged care homes.
• It has simple, succinct instructions.
• It preserves privacy by having no confidential clinical information on the outside of the envelope.
• It is resealable to enable ambulance officers and others repeated access to documents.
• It is used one-way for transfer in to hospital.
• It is a big (C4 ie bigger than A4) yellow envelope.
• It is low cost (49-66 cents each depending on size of print run).

The objective of the trial was to evaluate the use and usefulness of an aged-care home (ACH) transfer-to-hospital envelope (the Envelope) as a tool to support safe clinical handover when an ACH resident is transferred to an emergency department (ED).

NEVDGP was the lead agency for the trial in partnership with 6 other Divisions of General Practice- Melbourne East General Practice Network, Melbourne General Practice Network, Impetus, Pivot West, Northern Division of General Practice, and Westgate General Practice Network.

Participants in the study were 26 aged care homes (1545 beds) and the Emergency Departments of 6 major metropolitan public hospitals in Melbourne, and ambulance officers involved in transferring residents from ACHs to hospitals.  Transfer data was collected over an 18 week period (Jan-May 2008). Evaluation methods included written surveys and semi-structured face-to-face interviews.

The Envelope was used for the large majority of ACH residents transferred to hospital.

Participants

• ACH data: 317/355 (89%)
• ED data: 85/101 (84%)

Staff survey

• 163/165 ACH staff (99%) thought the Envelope was useful
• 148/165 (90%) said it was easy to use
• 128/165 ACH staff (78%) and all interviewees believed that using the Envelope improved clinical handover
• 152/165 ACH staff (92%) indicated they would continue to use the Envelope.
• All interviewees thought that using the Envelope had raised awareness of the need for clinical handover.

The Envelope is useful and easy to use. It is used in the large majority of transfers of ACH residents to EDs and is highly valued by ACH staff, ambulance officers and ED staff. Our results suggest that use of the Envelope makes clinical handover safer for the patient. Consistent positive findings indicate that the Envelope has the potential for much wider use.

•  Primary Care Support, Aged Care Initiative page of the NEVDGP website. Select "Transfer to Hospital Envelope".
•  Transfer-to-Hospital Envelope page of the Australian Commission on Safety and Quality in Health Care website.

Pushing the envelope: clinical handover from the aged-care home to the emergency department
Mary K Belfrage, Clare Chiminello, Diana Cooper and Sally Douglas
MJA Supplement on Clinical Handover 2009; 190: S117–S120.
This is a complete article on the pilot study. It is also available on the NEVDGP website.

Aged Care Program Officer, North East Valley Division of General Practice
Phone: 03 9496 4333