Category | Sub-category | Illustrative quotes |
---|---|---|
Patient and Family | Financial strain | If you are asking someone to transfer a loved one four hours [away], and they choose to be with that loved one for weeks on end, there is an economic cost to that. |
 |  | The cost of having to drive 40–50 miles to a tertiary center could be a barrier. |
 | Personal strain | To get to a place only to end up getting to another place that's further away I think adds a lot of emotional stress to family. |
 |  | Nobody wants their loved one a hundred miles away, particularly when they're sick. |
Physician | General agreement | I think it would be very difficult to get rural pulmonologists and critical care physicians to participate. |
 |  | I think it is better to cultivate some of the services locally. |
 | Loss of income | [They] stand to lose business. They don't want to lose the patients to the bigger hospitals. |
 |  | Everybody wants the payers; it's all money driven. |
 | Loss of autonomy | [Physicians will be] concerned that if they give up their patients they will never get them back. |
 |  | They like to take care of their patients no matter what. |
Source hospital | Loss of income | If they took all of our sick patients it could be devastating to our facility. |
 |  | Patients equals volume equals financial viability. |
 | Loss of care capacity | If they took away all our sick patients, we would become a fairly useless institution. |
 |  | It will lower the variety of care a nurse is exposed to and therefore they will have less growth potential in technology. |
Destination hospital | Overwhelmed resources | We're full all the time with what we've got. |
 |  | Nobody is equipped to handle that. We have trouble getting people in. Who's going to take those patients? |
 |  | Large facilities already divert patients regularly. |
 | Cost and reimbursement | Sometimes when you get the acutely ill in the ICU, they are coming with no insurance. |
 |  | Hospitals...have the potential for a great deal of financial woe, inheriting all the patients that might come to them for critical care without any reimbursement. |
System | Regulation | Lack of authority to do any of this. |
 |  | I can't envision a central triage system that would work without controversy. |
 | Cost and cost-effectiveness | Cost is going to be a huge barrier. |
 |  | Need to find out whether the outcome justifies the expense. |
 | Limited staffing | We basically cannot use all of our beds because of our nursing situation. |
 | Triage and infrastructure | The infrastructure is not there to do this. |
 |  | It would be hard to make the call quickly regarding where the patient should go. |
 |  | There would have to be additional [ambulance] rigs put into play so we're not missing the 911 calls. |