Table 3 Potential strategies to overcome barriers to regionalization of adult critical care.
Category | Sub-category | Illustrative quotes |
|---|---|---|
Communication | Continuity of care | I don't think it breaks continuity, as long as the destination facility is in regular communication with the referring facility and communication. |
|  |  | You need communication back and forth – standardized forms or processes between source and destination that everyone would use. |
| Â | Feedback | I think creating a mechanism for timely feedback of the care of those patients will be important. |
| Â | Information Technology | Centralized call center for all potential referrals to the main hospital. |
| Â | Â | Install the same software program between hospitals so that all records can be transferred electronically. Then you can push the records back and forth between facilities. |
Education | Develop and disseminate evidence of benefit | Education of families and of physicians of the need to do this and the benefits to this would be a tremendous asset. |
System design | Tier designation based on voluntary service level | It would have to be a mandated criteria for keeping patients at certain seriousness of illness, in order to support a facility that would pass some agency's inspection. |
| Â | Â | One solution would be to regionalize different strengths, if for instance, our hospital kept cardiac and CCU capabilities, and sent stroke patients to the other hospital. |
| Â | Broad stakeholder participation | EVERYONE would have to be involved. |
| Â | Objective triage criteria | Have criteria for what would warrant the patients being transferred. Therefore the doctor wouldn't feel like they failed. |
Reimbursement | Feedback revenue to referring centers | Reimbursement rates, so that the hospitals that are doing the transferring can have some reimbursement for the care of those patients. |
| Â | Â | Reimburse the sending hospital for at least a portion of the care. |
| Â | Transfer patients back to source hospitals after improvement | The patient is appropriately channeled back with the appropriate documentation. |
| Â | Â | If people need to have acute rehab, it should be back at the primary unit where the family support is. |