TY - JOUR
T1 - Barriers and facilitators to interhospital transfer of acute pulmonary embolism
T2 - An inductive qualitative analysis
AU - DeBerry, Jacob
AU - Rali, Parth
AU - McDaniel, Michael
AU - Kabrhel, Christopher
AU - Rosovsky, Rachel
AU - Melamed, Roman
AU - Friedman, Oren
AU - Elwing, Jean M.
AU - Balasubramanian, Vijay
AU - Sahay, Sandeep
AU - Bossone, Eduardo
AU - Farmer, Mary Jo S.
AU - Klein, Andrew J.P.
AU - Hamm, Megan E.
AU - Ross, Charles B.
AU - Rivera-Lebron, Belinda N.
N1 - Funding Information:
Funding was provided by a grant from the Boston Scientific Corporation to the PERT Consortium™.
Publisher Copyright:
Copyright © 2023 DeBerry, Rali, McDaniel, Kabrhel, Rosovsky, Melamed, Friedman, Elwing, Balasubramanian, Sahay, Bossone, Farmer, Klein, Hamm, Ross and Rivera-Lebron.
PY - 2023
Y1 - 2023
N2 - Background: Interhospital transfer (IHT) of patients with acute life-threatening pulmonary embolism (PE) is necessary to facilitate specialized care and access to advanced therapies. Our goal was to understand what barriers and facilitators may exist during this transfer process from the perspective of both receiving and referring physicians. Methods: This qualitative descriptive study explored physician experience taking care of patients with life threatening PE. Subject matter expert physicians across several different specialties from academic and community United States hospitals participated in qualitative semi-structured interviews. Interview transcripts were subsequently analyzed using inductive qualitative description approach. Results: Four major themes were identified as barriers that impede IHT among patients with life threatening PE. Inefficient communication which mainly pertained to difficulty when multiple points of contact were required to complete a transfer. Subjectivity in the indication for transfer which highlighted the importance of physicians understanding how to use standardized risk stratification tools and to properly triage these patients. Delays in data acquisition were identified in regards to both obtaining clinical information and imaging in a timely fashion. Operation barriers which included difficulty finding available beds for transfer and poor weather conditions inhibiting transportation. In contrast, two main facilitators to transfer were identified: good communication and reliance on colleagues and dedicated team for transferring and treating PE patients. Conclusion: The most prominent themes identified as barriers to IHT for patients with acute life-threatening PE were: (1) inefficient communication, (2) subjectivity in the indication for transfer, (3) delays in data acquisition (imaging or clinical), and (4) operational barriers. Themes identified as facilitators that enable the transfer of patients were: (1) good communication and (2) a dedicated transfer team. The themes presented in our study are useful in identifying opportunities to optimize the IHT of patients with acute PE and improve patient care. These opportunities include instituting educational programs, streamlining the transfer process, and formulating a consensus statement to serve as a guideline regarding IHT of patients with acute PE.
AB - Background: Interhospital transfer (IHT) of patients with acute life-threatening pulmonary embolism (PE) is necessary to facilitate specialized care and access to advanced therapies. Our goal was to understand what barriers and facilitators may exist during this transfer process from the perspective of both receiving and referring physicians. Methods: This qualitative descriptive study explored physician experience taking care of patients with life threatening PE. Subject matter expert physicians across several different specialties from academic and community United States hospitals participated in qualitative semi-structured interviews. Interview transcripts were subsequently analyzed using inductive qualitative description approach. Results: Four major themes were identified as barriers that impede IHT among patients with life threatening PE. Inefficient communication which mainly pertained to difficulty when multiple points of contact were required to complete a transfer. Subjectivity in the indication for transfer which highlighted the importance of physicians understanding how to use standardized risk stratification tools and to properly triage these patients. Delays in data acquisition were identified in regards to both obtaining clinical information and imaging in a timely fashion. Operation barriers which included difficulty finding available beds for transfer and poor weather conditions inhibiting transportation. In contrast, two main facilitators to transfer were identified: good communication and reliance on colleagues and dedicated team for transferring and treating PE patients. Conclusion: The most prominent themes identified as barriers to IHT for patients with acute life-threatening PE were: (1) inefficient communication, (2) subjectivity in the indication for transfer, (3) delays in data acquisition (imaging or clinical), and (4) operational barriers. Themes identified as facilitators that enable the transfer of patients were: (1) good communication and (2) a dedicated transfer team. The themes presented in our study are useful in identifying opportunities to optimize the IHT of patients with acute PE and improve patient care. These opportunities include instituting educational programs, streamlining the transfer process, and formulating a consensus statement to serve as a guideline regarding IHT of patients with acute PE.
KW - catheter–directed thrombolysis
KW - interhospital transfer
KW - pulmonary embolism
KW - pulmonary embolism response team
KW - surgical embolectomy
UR - http://www.scopus.com/inward/record.url?scp=85150209015&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85150209015&partnerID=8YFLogxK
U2 - 10.3389/fmed.2023.1080342
DO - 10.3389/fmed.2023.1080342
M3 - Article
C2 - 36936238
AN - SCOPUS:85150209015
VL - 10
SP - 1080342
JO - Frontiers in Medicine
JF - Frontiers in Medicine
SN - 2296-858X
M1 - 1080342
ER -