BMC health services research · 2025
Decision-making in interhospital transfer of traumatic brain injury patients: exploring the perspectives of surgeons at general hospitals and neurosurgeons at neurotrauma centres.
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Cuevas-Østrem Mathias, Wisborg Torben, Røise Olav, Helseth Eirik, Jeppesen Elisabeth
Аннотация
BACKGROUND: Traumatic brain injury (TBI) is a significant public health concern. Advancing age and comorbidities are associated with a reduced probability of being transferred to neurotrauma centres (NTCs) from non-neurosurgical acute care trauma hospitals (ACTHs). However, the extent to which these decisions reflect well-considered treatment-limiting decisions and which influence other factors have on the decision-making process remains unclear.
OBJECTIVE: To increase the understanding of adults' access to NTC care by exploring the decision-making process for interhospital transfer of patients with isolated TBI, elucidating factors influencing these decisions.
METHODS: Fifteen surgeons and neurosurgeons from four hospitals in Norway were recruited through purposive sampling to four semi-structured focus group interviews. Surgeons represented ACTHs and neurosurgeons NTCs, and all participants were responsible for TBI patients' initial care and transfer decisions. Interviews were thematically analysed.
RESULTS: We identified several factors influencing transfer decisions, captured in six main themes under one overarching theme; 'The chance of a favourable outcome'. The six main themes reflect surgeons' and neurosurgeons' decision-making process, which included clinical and system-level factors: (A) 'Establish TBI severity: Glasgow Coma Scale score and head CT', (B) 'Preinjury health status: comorbidity, functioning, and age', (C) 'Distance from ACTH to NTC: distance is time and time is brain', (D) 'Uncertainty and insecurity', (E) 'Capacity at NTC', and (F) 'Next of kin involvement'.
CONCLUSION: On-call surgeons and neurosurgeons responsible for making transfer decisions for TBI patients emphasise the importance of patient-centred decisions, including individual patients' risk factors and overall health status.
OBJECTIVE: To increase the understanding of adults' access to NTC care by exploring the decision-making process for interhospital transfer of patients with isolated TBI, elucidating factors influencing these decisions.
METHODS: Fifteen surgeons and neurosurgeons from four hospitals in Norway were recruited through purposive sampling to four semi-structured focus group interviews. Surgeons represented ACTHs and neurosurgeons NTCs, and all participants were responsible for TBI patients' initial care and transfer decisions. Interviews were thematically analysed.
RESULTS: We identified several factors influencing transfer decisions, captured in six main themes under one overarching theme; 'The chance of a favourable outcome'. The six main themes reflect surgeons' and neurosurgeons' decision-making process, which included clinical and system-level factors: (A) 'Establish TBI severity: Glasgow Coma Scale score and head CT', (B) 'Preinjury health status: comorbidity, functioning, and age', (C) 'Distance from ACTH to NTC: distance is time and time is brain', (D) 'Uncertainty and insecurity', (E) 'Capacity at NTC', and (F) 'Next of kin involvement'.
CONCLUSION: On-call surgeons and neurosurgeons responsible for making transfer decisions for TBI patients emphasise the importance of patient-centred decisions, including individual patients' risk factors and overall health status.