Article Text

Download PDFPDF
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

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

OpenUrlCrossRefPubMedWeb of Science

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 …

View Full Text


  • For correspondence: Dr S M Dy, Bloomberg School of Public Health and School of Medicine, Johns Hopkins University, Baltimore, MD, USA. sdy{at}

  • Source of funding: not stated.