Rural Interfacility Emergency Department Transfers: Framework and Qualitative Analysis.

Area of Science:

• Health Services Research
• Rural Health
• Emergency Medicine

Background:

• Interfacility transfers are crucial for rural emergency departments (EDs) to provide specialized care.
• Access to timely and specialized treatment is a key challenge for rural healthcare systems.

Purpose of the Study:

• To identify facilitators and barriers in the interfacility transfer process.
• To explore the implications of these transfers for rural emergency care and access.

Main Methods:

• Semi-structured interviews were conducted with ED staff at rural and urban Veterans Health Administration (VHA) hospitals.
• Data were analyzed using an iterative inductive-deductive approach to identify themes and develop a conceptual framework.

Main Results:

• Four themes emerged: patient factors, system resources, transfer processes/communication, and location decision.
• Resource limitations significantly impacted transfer processes, described as burdensome.
• The complexity of the transfer process, not perceived quality or patient preferences, primarily drove the location decision.

Conclusions:

• Interfacility transfers are complex, resource-dependent processes influencing location decisions.
• Simplifying transfer processes and tracking transfer boarding could improve rural emergency care.
• Addressing resource needs is critical for effective interfacility transfers from rural EDs.