A lack of guidelines and fragmented systems can impede success.
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A receiving hospital's inability to offer any additional benefit is a common issue with transfers, according to research.
In his role as executive director for clinical operations with Pittsburgh-based TeleTracking, which develops automated patient flow systems, Scott Newton, DNP, RN, tracks what happens to transferred patients after they arrive at a tertiary center. His analysis has revealed that 20% of patients are discharged within 24 to 48 hours without receiving any procedure or intervention.
“The question of why patients are transferred is difficult to answer because there is no one central place where providers are documenting the underlying reasons,” said Dr. Mueller. “It is still largely a nonstandardized process.”
A study led by Dr. Mueller and published in the June 2018 JHM found that between 32% and 89% of transferred patients did not receive any associated specialty procedure at the receiving hospital. These patients may have been transferred for other reasons, such as comorbidities, hospital location, prior relationship with the hospital, or desire for a second opinion, the authors noted.
However, the explanation for a transfer might sometimes be as simple as first come, first served. A recent analysis of one regional transfer network, published in the January 2018 Joint Commission Journal on Quality and Patient Safety, found that surgeons at the tertiary center automatically accepted all patients referred by the outlying hospitals, regardless of outcome or resource considerations. Transfers were refused only when the hospital ran out of beds.
In such systems, care is not always fairly distributed, said study coauthor Michael Ward, MD, assistant professor of emergency medicine at Vanderbilt University Medical Center in Nashville, Tenn. Referring surgeons, who may be feeling pressure from families, might seek to transfer dying patients in order to exhaust treatment options, even when the benefit is uncertain, he suggested. Meanwhile, beds are denied to patients who have the potential for better outcomes.
The involvement of an appropriate specialist—a hepatologist in the case of a potential liver transplant, for example—in the transfer discussion can help avoid this problem, the experts recommended. This also adds credibility to the transfer decision and reassures transferring clinicians, patients, and families that the right decision is being made.