Background: Tertiary hospitals and academic medical centers often operate near full capacity while smaller community hospitals have difficulty filling open beds. At our institution, a program was set up to transfer lower acuity patients needing admission from the emergency department of an academic medical center to a community partner hospital for direct admission. This and similar programs match patient acuity with site of care, free up beds at the tertiary care hospital, and reduce time spent boarding in the emergency department. Studies of patient experience for such transfers are limited.

Methods: We conducted structured telephone interviews with randomly selected participants among the 492 patients transferred between February 2019 and February 2020. The interviews contained fixed response and open-ended questions focusing on the transfer process and rationale, care quality, and financial implications of the transfer. We used descriptive statistics to summarize questions with fixed responses and thematic analysis for open-ended questions.

Results: We surveyed 40 participants who were broadly representative of the patient population at our institution. Most participants (35/40, 88%) understood the rationale for the transfer, citing bed availability and shorter wait times as primary reasons. However, although the transfer was voluntary and patients opted in, many (24/40, 60%) felt that they did not have a choice in the decision to transfer. Patients generally had a positive experience with the transfer process itself (31/40, 78%) and the overall care experience (27/40, 68%). However, for a minority of patients (7/40, 18%), the process turned out to be financially complicated with multiple hospital bills or unexpected transfer ambulance bills.

Conclusions: A program to match acuity and capacity by transferring patients from an emergency department of a larger hospital to a smaller one is generally well-received by patients. Participants understand the reasons for transfer but may perceive a lack of agency in the decision, driven by limited time to explain the process in a busy emergency department, the power dynamic in a patient-doctor relationship or the acuity of their illness. Patients warrant a clear explanation of benefits of the program, guidance that it is voluntary, and protection from incremental costs associated with the transfer.