From the Section of Hospital Medicine, University of Chicago, Chicago, Illinois.
Division of Hospital Medicine, University of California San Francisco, San Francisco, California.
J Patient Saf. 2024 Apr 1;20(3):216-221. doi: 10.1097/PTS.0000000000001203. Epub 2024 Feb 12.
There is a lack of evidence-based guidelines to direct best practices in interhospital transfers (IHTs). We aimed to identify frontline physicians' current and ideal reasons for accepting IHT patients to inform future IHT research and guidelines.
We conducted a cross-sectional survey of hospitalist physicians across 11 geographically diverse hospitals. The survey asked respondents how frequently they currently consider and should consider various factors when triaging IHT requests. Responses were dichotomized into "highly considered" and "less considered" factors. Frequencies of the "highly considered" factors (current and ideal) were analyzed. Write-in responses were coded into themes within a priori domains in a qualitative analysis.
Of the 666 hospitalists surveyed, 238 (36%) responded. Respondents most frequently identified the need for specialty procedural and nonprocedural care and bed capacity as factors that should be considered when triaging IHT patients in current and ideal practice, whereas the least frequently considered factors were COVID-related care, insurance/financial considerations, and patient/family preference. More experienced respondents considered patient/family preference more frequently in current and ideal practice compared with less experienced respondents (33% versus 11% [ P = 0.0001] and 26% versus 9% [ P = 0.01], respectively). Qualitative analysis identified several themes in the domains of Criteria for Acceptance, Threshold for Acceptance, and Indications for Physician-to-Physician Communication.
This geographically diverse sample of hospitalist physicians responsible for accepting IHT patients showed general agreement between primary factors that are currently and that should be considered for IHT acceptance, with greatest weight placed on patients' need for specialty care.
目前缺乏循证指南来指导医院间转院（IHT）的最佳实践。我们旨在确定一线医生目前和理想的接受 IHT 患者的原因，以为未来的 IHT 研究和指南提供信息。
我们对 11 家地理位置不同的医院的医院医生进行了横断面调查。该调查询问了受访者在分诊 IHT 请求时，他们目前和应该考虑各种因素的频率。将回答分为“高度考虑”和“较少考虑”因素。分析了“高度考虑”因素（当前和理想）的频率。在定性分析中，将书面答复按照预先确定的主题进行编码。
在接受调查的 666 名医院医生中，有 238 名（36%）做出了回应。受访者最常确定需要专业的程序和非程序护理以及床位容量，作为在当前和理想实践中分诊 IHT 患者时应考虑的因素，而最少考虑的因素是与 COVID 相关的护理、保险/财务考虑因素和患者/家属的偏好。与经验较少的受访者相比，经验更丰富的受访者在当前和理想实践中更频繁地考虑患者/家属的偏好（33%比 11%[P=0.0001]和 26%比 9%[P=0.01]）。定性分析确定了接受标准、接受阈值和医生间沟通指征等领域的几个主题。
负责接受 IHT 患者的来自不同地理位置的医院医生样本普遍认为，目前和应考虑接受 IHT 的主要因素一致，最看重患者对专科护理的需求。
