Hospitals transfer patients for a variety of reasons, and almost all of them can be anticipated and planned for.
In an ideal scenario, a hospitalized patient would remain within a single facility until such time that he or she is ready for discharge to a post-acute facility or the home setting.
That doesn’t always happen. In fact, there are a number of reasons why a patient would need to be transferred between facilities before their acute clinical needs are met. The reasons are varied and run the gamut from ensuring the best patient experience possible to dealing with the reality of a constrained system.
In this article, we’ll answer the question: Why do hospitals transfer patients? If you’re looking for a high-level overview, here are the top 4 reasons:
- Lack of Capability
- Lack of Capacity
- Insurance/Payor Issues
- Patient Choice
Let’s look at each of these in turn to explore exactly what would lead to a patient being transferred to another facility.
Lack of Capability
One of the most common reasons for transferring patients is that the referring facility simply lacks the services or level of care that a patient’s condition demands. This is often the case when transferring a surgical patient from a rural or regional hospital to a tertiary care hospital, such as a patient with severe trauma whose treatment requires services that may only be available at a Level 1 trauma center.
This need to transfer may be obvious as soon as the patient presents at the referring facility – as in the trauma example – or it may become apparent if/as a patient’s condition deteriorates. The simple truth is patients don’t always respond to treatment the way the evidence suggests they will. Medication may lead to an adverse reaction due to a previously unknown allergy. An elective surgical procedure could reveal a heretofore undiagnosed medical condition requiring further intervention. A patient ready to be discharged may sustain a hospital-acquired infection or a slip-and-fall that aggravates a more severe injury.
Many of these issues could be handled in-hospital, but that’s not always the case. If the patient’s condition requires a level of specialization or testing that their current acute care facility isn’t equipped for, he or she may need to be transferred.
There are certain facilities where this is more common than others. An academic medical center, for instance, likely has sufficient scope and resources to serve patients under most circumstances. But a critical access hospital with a small surgical unit may not be prepared to handle an influx of multiple patients at once or to care for a patient whose ongoing stay reveals the need for a specialization such as mental health care.
Tied closely to changing clinical requirements is the availability of staff with the experience necessary to help patients whose acuity needs progress over the course of their hospital stay.
This is of particular concern following emergency care. After triage has been completed, a physician must determine what the individual’s subsequent needs are. If a hospitalist isn’t sufficient and a specialty physician isn’t available, a transfer to another hospital with the right expert may be in order.
Sometimes it’s the capabilities of the team surrounding the physician that matters. Again, this is an issue that usually rears its head with resource-constrained facilities such as critical access hospitals (but it can even occur in larger facilities). If a patient requires an MRI scan but the mobile MRI unit the hospital relies on won’t be available for days, then a transfer to a facility where imaging staff can immediately attend to the patient’s needs might be the right choice.
A field as varied as healthcare has so many specialties that there’s no single hospital within the country capable of diagnosing and treating every possible medical condition that could arise. Even in an era of mergers and acquisitions, where a single health system may encompass numerous hospitals across state lines, some patients will still require a transfer in order to connect with physicians at the tops of their fields.
Look for this type of transfer to become increasingly common as healthcare confronts a severe staffing shortage in the coming years.
Lack of Capacity
This is something that thankfully doesn’t occur too often, but the pandemic showed us that this can and does happen.
There are times when a patient may need to be transferred because a hospital lacks the resources or capacity necessary to properly care for them. An individual deemed not at high risk of immediate adversity may be transferred to another hospital in order to expand ICU capacity and allow clinical staff to attend to the most at-risk patients. You saw this happen again and again during the pandemic as ICUs became strained and certain hospitals worked overtime to find somewhere, anywhere, to put patients whose health was declining rapidly.
Conversely, a high-risk patient may be quickly transferred via ambulance to a facility that has been set up for heavy ICU volume so that the originating hospital can care for the lower risk patients they’re more capable of handling.
It’s important to note that this can and does happen in “normal” times as well. If a hospital relies on aging equipment or archaic software due to budget constraints, any failure in either hardware or software can compromise the hospital’s ability to effectively move patients through the care journey, leading to an eventual patient transfer if needs can’t be met.
Staffing is another concern. As physician and nursing shortages loom large in the coming decade, hospitals are likely to confront a scenario where, although they have the physical space necessary to accept more patients, they don’t have the staff available to treat those individuals. To avoid turning away patients, It will become increasingly important for health systems to have real-time visibility into their staffing levels and patient volume at any given time for all facilities. To achieve something approaching uniformity in volume, this will be necessary in order to coordinate patient flow to those parts of the system capable of accepting new patients.
Finally, a hospital may transfer a patient because the patient’s insurance doesn’t cover the services they require at the point-of-entry hospital.
This is most common when a patient enters a hospital via the emergency department, is triaged, and then has to be transferred to a facility where they can have their needs met within the parameters of their payor network. It can also happen when a patient ends up requiring a higher degree of specialization than initially anticipated, and point-of-entry hospital isn’t in network. In this case, they may have to transfer to have their needs met.
Of course, a health system isn’t going to eject a patient who lacks the proper coverage. But there may be instances where, after the patient’s initial acute care needs are met, a case worker may meet with the patient to connect them with providers who are within their network. Or, if the patient is uninsured, the case worker can provide resources and information about the facilities willing to provide for those individuals’ subsequent care needs, initiating transfers as necessary.
These decisions are never easy, but they do happen, and bringing visibility to what’s covered within your hospital, for which patients, can streamline the process.
Yet another reason hospitals may decide to transfer patients is simply because the patient requests it.
This can be due to what the patient perceives as a poor experience, leading to the patient or family member taking steps necessary to switch facilities. Sometimes it’s a matter of the patient wanting to be closer to family, especially if a stay proves lengthier than he or she had initially anticipated.
The best thing a hospital can do to prevent transfers stemming from patient request is to provide the best experience possible and, when a request is made, make an effort to understand why the patient made their request and take steps to address their underlying concerns.
Transferring Patients: Learn to Avoid Surprises
Every patient a hospital is forced to transfer for the above reasons can not only lead to a compromised patient experience but can also create revenue leakage.
It’s incumbent upon hospitals to plan for each step of the patient’s journey as best they can, including how and when to transfer patients. Hospitals should have data available to anticipate when the likelihood of a patient transfer increases and when a transfer may actually be in the patient’s, and the hospital’s, best interests.
As transfers become more common, this kind of planning will become critical for swiftly ushering patients into, out of and around health systems.
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