Multi-Institution Survey of Accepting Physicians’ Perception of Appropriate Reasons for Interhospital Transfer: A Mixed-Methods Evaluation

Abstract

Objectives 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. Methods 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. Results 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. Conclusions 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.