Facilitators and inhibitors of traumatic brain injury transfers - a fieldwork investigation

Aim: Intensified healthcare specialization has increased the need for patient transfers.
We aimed to describe in-hospital
and interhospital patient transfer decisions during
the traumatic brain injury (TBI) trajectory from a nursing perspective.
Design: Ethnographic fieldwork.
Methods: We used participant observation and interviews at three sites representing
the acute, subacute and stable stages of the TBI trajectory. Deductive analysis was
applied supported by transition theory.
Results: During the acute stage (neurointensive care), transfer decisions were facilitated
by physicians assisted by critical care nurses, in the subacute stage (highly
specialized rehabilitation), transfer decisions were collaborative among in-house
healthcare professionals, community staff and family, and during the stable stage
(municipal rehabilitation), transfer decisions were made by non-clinical
staff. Most of
the resources allocated during the trajectory went towards highly specialized rehabilitation,
whereas more resources are needed during the end of the trajectory.
No Patient or Public Contribution: Patients and the public were not involved in this
study .