Journal article
Rural Interfacility Emergency Department Transfers: Framework and Qualitative Analysis
The western journal of emergency medicine, Vol.21(4), pp.858-865
07/01/2020
DOI: 10.5811/westjem.2020.3.46059
PMCID: PMC7390588
PMID: 32726256
Abstract
Introduction: Interfacility transfers from rural emergency departments (EDs) are an important means of access to timely and specialized care.
Methods: Our goal was to identify and explore facilitators and barriers in transfer processes and their implications for emergency rural care and access. Semi-structured interviews with ED staff at five rural and two urban Veterans Health Administration (VHA) hospitals were recorded, transcribed, coded, and analyzed using an iterative inductive-deductive approach to identify themes and construct a conceptual framework.
Results: From 81 interviews with clinical and administrative staff between March-June 2018, four themes in the interfacility transfer process emerged: 1) patient factors; 2) system resources; and 3) processes and communication for transfers, which culminate in 4) the location decision. Current and anticipated resource limitations were highly influential in transfer processes, which were described as burdensome and diverting resources from clinical care for emergency patients. Location decision was highly influenced by complexity of the transfer process, while perceived quality at the receiving location or patient preferences were not reported in interviews as being primary drivers of location decision. Transfers were described as burdensome for patients and their families. Finally, patients with mental health conditions epitomized challenges of emergency transfers.
Conclusion: Interfacility transfers from rural EDs are multifaceted, resource-driven processes that require complex coordination. Anticipated resource needs and the transfer process itself are important determinants in the location decision, while quality of care or patient preferences were not reported as key determinants by interviewees. These findings identify potential benefits from tracking transfer boarding as an operational measure, directed feedback regarding outcomes of transferred patients, and simplified transfer processes.
Details
- Title: Subtitle
- Rural Interfacility Emergency Department Transfers: Framework and Qualitative Analysis
- Creators
- Candace D. McNaughton - Vanderbilt University Medical CenterKemberlee Bonnet - Vanderbilt University Medical CenterDavid Schlundt - Vanderbilt University Medical CenterNicholas M. Mohr - University of IowaSuemin Chung - Vanderbilt University Medical CenterPeter J. Kaboli - University of IowaMichael J. Ward - Vanderbilt University Medical Center
- Resource Type
- Journal article
- Publication Details
- The western journal of emergency medicine, Vol.21(4), pp.858-865
- DOI
- 10.5811/westjem.2020.3.46059
- PMID
- 32726256
- PMCID
- PMC7390588
- NLM abbreviation
- West J Emerg Med
- ISSN
- 1936-900X
- eISSN
- 1936-9018
- Publisher
- Westjem
- Number of pages
- 8
- Grant note
- U1C-RH29074 / Rural Telehealth Research Center - Federal Office of Rural Health Policy, Health Resources and Services Administration (HRSA) K23HL127130 / National, Heart, Lung, and Blood Institute; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI) 2017 Heart Failure Society of America/Emergency Medicine Foundation Acute Heart Failure Young Investigator Award - Novartis Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC) K23HL125670 / National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA CIN 13-412 / Office of Research and Development, Health Services Research and Development (HSR&D) Service through the Comprehensive Access and Delivery Research and Evaluation (CADRE) Center ORH-10808 / Department of Veterans Affairs, Veterans Health Administration, VA Office of Rural Health; US Department of Veterans Affairs W81XWH-17-C-0252 / Department of Defense from the CDMRP Defense Medical Research and Development Program
- Language
- English
- Date published
- 07/01/2020
- Academic Unit
- Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center; Internal Medicine
- Record Identifier
- 9984296139302771
Metrics
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