From the Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA.
J Patient Saf. 2021 Dec 1;17(8):e752-e757. doi: 10.1097/PTS.0000000000000501.
Although existing data suggest marked variability in interhospital transfer (IHT), little is known about specific factors that may impact the quality and safety of this care transition. We aimed to explore transferred patients' and involved physicians' experience with IHT to better understand the components of the transfer continuum and identify potential targets for improvement.
We performed a qualitative study using individual interviews of adult patients recently transferred to cardiology, general medicine, and oncology services at a tertiary care academic medical center, as well as their transferring physician, accepting attending physician, and accepting/admitting resident physician. We conducted a thematic analysis, using an inductive approach and an a priori framework from pre-established domains.
Participants included 10 hospitalized adults (6 cardiology, 2 general medicine, and 2 oncology), 9 accepting attending physicians, 12 accepting and/or admitting resident physicians, and 5 transferring physicians (N = 36). Emergent themes demonstrated that participants held a shared understanding of the reason for transfer (most commonly access to more specialized care), and relayed a general dissatisfaction regarding the timing and lack of advanced notification of transfer. We also found distinct differences in IHT experience by stakeholder group: physician participants relayed discontent with intrahospital chains of communication and interhospital information exchange, and patient participants focused more readily on the physical aspects of IHT.
This study offers insight into IHT from the perspective of those most affected by this process, thereby identifying potential targets in addressing the quality and safety of this transition.
尽管现有数据表明医院间转院（IHT）存在明显差异，但对于可能影响这种医疗转衔质量和安全的具体因素知之甚少。我们旨在探讨转院患者和相关医生的 IHT 体验，以更好地了解转衔连续体的组成部分，并确定潜在的改进目标。
我们采用定性研究方法，对一家三级保健学术医疗中心的心血管科、普通内科和肿瘤科最近转院的成年患者及其转院医生、接收主治医生、接收/住院医生进行了个体访谈。我们采用了一种主题分析方法，使用了预先确定的领域中的归纳方法和预设框架。
参与者包括 10 名住院成人（6 名心内科、2 名普通内科和 2 名肿瘤科）、9 名接收主治医生、12 名接收和/或住院医生以及 5 名转院医生（共 36 名）。出现的主题表明，参与者对转院的原因（最常见的是获得更专业的治疗）有共同的理解，并对转院的时间和缺乏提前通知表示普遍不满。我们还发现，不同利益相关者群体的 IHT 体验存在明显差异：医生参与者对医院内沟通链和医院间信息交换感到不满，而患者参与者更关注 IHT 的实际方面。
这项研究从最受这一过程影响的人的角度提供了对 IHT 的深入了解，从而确定了在解决这一过渡的质量和安全方面的潜在目标。
