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