Mixed methods study of the interfacility transfer system utilizing both patient-reported experiences and direct observation of the transfer consent process

Mixed methods study of the interfacility transfer system utilizing both patient-reported experiences and direct observation of the transfer consent process
L Stewart, D Bille, B Fields, L Kemper, C Pappa, E Orman, M Boustani, E Ramly, A Hybarger, A Watters, N Glober
The Joint Commission Journal on Quality and Patient Safety, 14 January 2025
Abstract
Background
Interfacility transfer is an integral component of the modern healthcare system. However, there are no commonly agreed-upon standards for interfacility processes or for patient engagement and shared decision-making in transfer, and little is known about their experience. This study used qualitative methods to better understand the patient and care partner experience with interfacility emergency department (ED)-to-ED transfer.
Methods
This mixed methods study used two distinct data sources: (1) semi-structured interviews of older adult patients and their care partners, performed at bedside in a large, tertiary care hospital (i.e., receiving facility) following interfacility transfer, and (2) direct observation of the transfer consent process at two community emergency departments (i.e., referring facilities) in the same health system.
Results
A total of 21 patients and 14 care partners were interviewed. We identified several common themes related to perceptions and experiences with interfacility transfer: (1) communication (e.g., perceived lack of agency), (2) logistics (e.g., wait times), (3) impacts on family (e.g., distance from home), (4) uncertainty about the bill (e.g., transfer-associated costs), and (5) quality of care (e.g., greater trust in tertiary care centers). We also conducted direct observations of the transfer consent process for 14 unique patient encounters. We observed considerable variability in practice patterns among sending clinicians and identified frequent patient-reported issues related to transfer logistics and effective communication, including distractions, lack of privacy, absence of support system, physical pain and/or psychological stress, preferred language, and health literacy.
Conclusions
These data suggest several potential areas for improvement in the care of patients requiring interfacility transfer, to increase engagement and allow patients and their care partners to make better-informed decisions most consistent with their goals of care.