7 Understanding Regional Site Transfer: Perceptions of Health Care Professionals

Abstract

Abstract Background Alberta Health Services identified that tertiary sites are often in overcapacity (admitted patients exceeding inpatient beds) while regional sites have low occupancy in their pediatric inpatient units. Hospital overcapacity may have negative effects on the care received by patients, such as increased risk of infection, less time spent with each patient and increased stress on the hospital staff (Keegan, 2010). In addition, rural families face several barriers to access to health care including traveling long distances to access the sub-specialty care present in urban tertiary centers. Previous studies conducted by our team found that transfers back to regional sites are not common. Increasing transfers of pediatric patients from tertiary to regional sites with care supported by the tertiary site could aid in addressing tertiary overcapacity and enable patients and families to receive care closer to home. Objectives This qualitative study sought to understand tertiary site health care professionals’ perceptions of tertiary to regional inpatient transfer. Design/Methods Four semi-structured focus groups were held with health care professionals. Focus groups included a mixed group of staff physicians, residents, nurses and managers. Common themes of discussion included the current transfer process, understanding of regional site resources and ways to increase patient transfer. A qualitative data analysis software, NVivo 11, was used to code, organize, and manage the data to facilitate data interpretations and generate themes regarding the current patient transfer process. Results The main barriers of pediatric transfer to rural sites include a lack of standardized transfer guidelines, limited understanding of rural regional site resources and mistrust between medical teams that prohibit patient transfer. The most likely pediatric patients that could be transferred back to rural sites include clearly diagnosed, single body system patients. Participants who had previous experience working in regional sites were more comfortable with transfer to regional sites. Transfer to regional sites could be increased by improving communication between medical teams and correcting misinformation about regional inpatient pediatric sites. Conclusion There is a historical practice of concentrating resources at tertiary care sites. However, there are a lack of shared guidelines for transfer as well as well as limited knowledge of regional site capabilities. Health care professionals across the entire continuum of patient care recognize the need to find solutions that would aid in transfer.