(1724) Obligated to Say "Yes": The How and Why Behind Transfer Decisions in Moribund Patients

Introduction: A core principle of trauma care is the rapid transport of severely injured patients to hospitals capable of providing definitive care. The social, financial, and emotional burdens associated with transfers, as well as their impact on hospital crowding, necessitate a reconsideration of this approach. Limited information exists, however, on how physicians actually make the decision to transfer a potentially moribund patient. We therefore sought to better understand these factors as the next step towards optimizing transfer flow and patient care.

Methods: We conducted semi-structured interviews with emergency physicians at referring and referral centers. Interviews were transcribed and subject to thematic analysis.

Results: We conducted 16 interviews with both referring and receiving physicians. We identified four emergent themes that underpinned a decision to transfer or accept a potentially moribund trauma patient: (1) accepting physician’s perceived obligation to hospitals with fewer resources, (2) the difficulty of prognostication, (3) the imperfection and limitations of current advanced care planning documents, and (4) the impact of family and patient preferences.

Conclusions: The rationale behind initiating and accepting transfers of moribund trauma patients is multifaceted and this study is the first of its kind to explore physician decision making in this domain. Physicians feel an obligation to patients, families, and other hospitals, which leads to almost universally initiating or accepting transfers even in cases with limited hope of survival. These interviews offer insight into potential opportunities to improve statewide trauma operations and highlight new avenues for promoting transfer decision heuristics and pre-transfer goals of care conversations without compromising patient care.