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Table 2 Barriers to regionalization of adult critical care.
| 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. |
