The consequence of saying "no": Triage and moral injury in inter-hospital transfers

Moral injury in healthcare is not limited to face-to-face care; the virtual healthcare space has significant potential for emotional distress stemming from challenging triage decisions. This perspective article is written from the vantage of hospitalists practicing virtual hospital medicine and administrative triage as part of a transfer center for a large academic health system. In this article, the authors highlight reasons behind how moral injury occurs in the virtual healthcare space including instances where capacity concerns require triage of resources leading to delays in patient care. Solutions proposed to minimize moral injury for transfer center clinicians include education around triage and virtual hospital medicine systems, establishing interhospital transfer standards of care, examining innovative strategies to address capacity constraints, and creating a system that diffuses the responsibility of transfer decisions so that one individual does not bare the sole weight of each morally consequential decision.