SHM Converge Scientific Abstract ePoster Gallery-Accept or Not? Understanding Hospitalist Criteria for Triaging Interhospital Transfers

Pdf Summary

This study surveyed 238 hospitalists across 11 geographically diverse programs in the Hospital Medicine Reengineering Network to understand how they currently triage interhospital transfer (IHT) requests and what factors they believe should be considered. The motivation was that there are few evidence-based guidelines for transfer decisions, despite evidence that some transferred patients have higher costs, longer hospital stays, and higher mortality.<br /><br />Hospitalists rated several factors, including specialty procedural and non-procedural care needs, bed capacity, continuity of care, COVID-related care, patient/family preference, and insurance/financial issues. Overall, there was strong agreement between what physicians currently consider and what they think should be considered. The most important factor was need for specialty care, especially procedural care. The least important factors were COVID-related care, insurance, and patient/family preference.<br /><br />An interesting finding was that more experienced hospitalists were more likely to consider patient/family preference than less experienced physicians. Open-ended responses revealed additional themes: some physicians consider whether alternatives to transfer exist, such as telemedicine or outpatient follow-up; some described an “accept all” culture; others reported a low threshold for acceptance due to fear of litigation; and some calibrated acceptance more strictly because of bed shortages and limited capacity. Physicians also said they seek direct physician-to-physician communication when more clinical clarification is needed.<br /><br />About half of respondents reported that their institution had formal criteria for IHT acceptance, and fewer than half had received training in IHT triage. The authors conclude that understanding frontline hospitalists’ real-world decision-making can help inform future transfer guidelines, but future work should include patients, families, and transferring clinicians.

Asset Subtitle

Khanh T. Nguyen

Meta Tag

Author List Khanh T. Nguyen, Stephanie Mueller

Category Research

Concept Pediatric Inter-Hospital Transfer

Concept Triage Criteria

Concept Specialty Care Needs

Concept Hospitalist Decision-Making

Concept Bed Capacity

Distinguished Non-Finalist

Presenter Organization University of Chicago

Presenting Author Khanh T. Nguyen

Track Transitions of Care

Keywords

interhospital transfer

hospitalists

transfer triage

specialty care

procedural care

bed capacity

patient preference

hospital medicine

transfer guidelines

physician decision-making

Pediatric Inter-Hospital Transfer

Triage Criteria

Specialty Care Needs

Hospitalist Decision-Making

Bed Capacity