From Challenges to Solutions: A Qualitative Thematic Analysis of Inter-hospital Transfer Processes

Inter-hospital transfers (IHT-the transfer of patients between acute care hospitals) are increasingly common. Understanding how to improve IHTs, reduce adverse events, and limit inappropriate transfers remains a top research and clinical practice priority for this high-risk care transition.

To identify improvement strategies to address gaps in current IHT practices and describe barriers to implementation of these improvement suggestions.

A qualitative study using focus groups. Participants Eligible participants were patients, caregivers, transferring physicians who seek to transfer patients, accepting physicians who receive requests for an IHT, and hospital system leaders. Participants were from tertiary/quaternary care hospitals and affiliate referral hospitals in the USA. Approach Case vignettes based on real clinical examples describing distinct IHT scenarios guided focus group discussions, which were facilitated using a semi-structured focus group guide. Data were analyzed using thematic analysis.

Seven 1-h focus groups with 39 participants were conducted with 6 Patient and Family Advisory Council (PFAC) members, 9 transferring clinicians, 12 accepting clinicians, and 12 leadership personnel. Participants represented 13 tertiary, quaternary care hospitals and affiliate referral hospitals geographically dispersed across the USA. Participants identified four overarching problems with IHTs: (1) communicating and engaging patients and families, (2) specialist involvement in IHT decision-making processes, (3) communication and information sharing challenges between hospitals, and (4) capacity management. Improvement strategies centered around engaging patients and families consistently in IHT decision-making, increasing the involvement of specialists, and creating standardized approaches to communication, workflows, and handoffs.

Our study offers potential solutions to gaps in IHT processes and then proactively identifies potential barriers to these solutions. These findings provide hospital system and clinician leaders with new insights to improve IHTs.