Re-envisioning interhospital transfer: A qualitative study exploring alternatives to transfer.

Background: Interhospital transfer (IHT, the transfer of patients between acute care hospitals) is often undertaken to provide patients with specialized care. However, mounting hospital capacity pressures suggest a need for re-envisioning IHT with consideration of alternatives to transfer in select patients.

Methods: We conducted a qualitative focus group study with key informants involved in IHT, including patient/family representatives, accepting and transferring clinicians, and hospital leadership. We used case examples of distinct IHT scenarios and a semi-structured focus group guide to explore aspects of the IHT process and potential alternative modalities of care. Data were analyzed using thematic analysis, with data coded into sub-themes and higher order themes until thematic saturation was achieved.

Results: We conducted a total of 7 focus groups, involving 6 patient/family representatives, 12 accepting clinicians, 9 transferring clinicians, and 12 hospital leadership from 13 geographically diverse hospitals. Within the higher order theme of "clinically appropriate alternatives to transfer," we identified several sub-themes, including transferring hospital support, ambulatory alternatives, and patient and organizational risks and benefits. Within the higher order theme of "feasibility and barriers to identified alternatives" we identified three sub-themes, including clinician unease about expansion of clinical scope, lack of healthcare infrastructure to support tele-health care, and limited outpatient capacity.

Discussion: In this qualitative study of key informants involved in IHT, we identified several viable alternatives to IHT and revealed potential barriers that could impede their widespread implementation. These insights provide optimal targets for advancing efforts to develop and operationalize new care models, re-envisioning IHT management.