Background: Inter-hospital transfer (IHT) – the transfer of patients between acute care hospitals – is associated with higher mortality, increased hospitalization costs, and longer length of stay compared to patients admitted from the emergency department. Despite these risks, best practices for IHT care coordination remain limited. This study characterizes patient and care partner experiences, needs, and preferences during IHT to inform patient-centered IHT care delivery.
Methods: We conducted semi-structured interviews from 11/2024-12/2024 with adults who were transferred from outside hospitals to hospital medicine teams at a quaternary care hospital and their care partners. Questions were based on the Agency for Healthcare Research and Quality’s Care Coordination Measurement Framework and prior IHT literature. We applied both inductive and deductive coding and performed thematic analysis until thematic saturation was achieved.
Results: We interviewed 14 patients and 12 care partners (n=26), of which 23% resided in the accepting hospital’s metroplex, 42% resided elsewhere in the state, and 35% resided out of state. Eight (57%) patients were male and six (43%) were in the 40-64 year-old age group. Among care partners, 75% were female and half were in the 65-69 year-old age group. We present participant IHT experiences across three timeframes and their process improvement suggestions:Pre-transfer: Transfer decisions were often framed as medical necessities rather than shared decisions involving discussion of benefits, risks, and burdens. While the reason for transfer was often clear, logistical details, such as transportation and timing, were vague. Participants described a “hurry up and wait” experience: bed availability and transport delays followed by sudden urgency when a bed opened and/or transport arrived.During transport: Patients reported overall positive experiences with transport teams, noting attentiveness to comfort and needs. Care partners faced challenges managing their own travel logistics and attending to household responsibilities.Post-transfer: Arrival experiences varied. Some patients faced confusion about bed location while others observed smooth intake processes. Communication about care plans, particularly about medications and procedures, was variable. For patients with cognitive impairment, care partners’ physical presence was key for advocacy and care coordination. Commonalities: Participants appreciated that transfers advanced patient care. Throughout the process, it was notable that patients were often responsible for notifying care partners of any updates. Those with prior hospitalization or transfer experience were better prepared to manage expectations.Suggestions: Clear transfer timeframes, clinician updates to care partners, care partner logistical support, and improved communication between clinical teams about pre-transfer care provided and post-transfer care plans.
Conclusions: Overall, patients and care partners valued that transfers advanced patient care. Experiences with communication and logistical support varied, particularly regarding transfer timing, care partner preparation, and the sharing of clinical information between teams. To deliver more patient-centered IHT care, best practices should include timely updates on transfer status, organized logistical support for care partners, and clear interdisciplinary and inter-hospital communication that actively involves patients and care partners.