Evid Based Nurs 9:93 doi:10.1136/ebn.9.3.93
  • Qualitative

Thresholds for requesting transfers to tertiary care were influenced by perceptions of the current illness and differences in perceptions of the initial hospital and tertiary care centre

 Q Why do patients or their surrogates request transfers to tertiary care?


Qualitative interview study with ethnographic decision modelling.


A large regional tertiary care centre in Baltimore, Maryland, USA.


Purposeful sample of 32 patients 37–92 years of age (mean age 64 y, 53% women, 87% white) (or their surrogate decision makers) who were transferred to tertiary care. Exclusion criteria were patients transferred as part of a regionalised care system, including psychiatry, trauma, and neonatal intensive care patients; and patients transferred for insurance purposes.


Semistructured interviews were conducted during the patients’ hospital stay at the accepting hospital within 2 weeks of transfer. Questions addressed patients’ roles in decision making, perceptions of the decision making process, reasons for transfer, and factors influencing the decision. Data collection and analysis used an iterative process. Ethnographic decision modelling was used to develop an influence diagram of the decision to request a transfer.


The …

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