Clare Walters

Background Inter-hospital transfers (IHT) from Emergency Departments occur when a patient requires transfer to an alternative facility for speciality treatment and are often time critical. Inter-Hospital Transfer may require an escort from the referring hospital, either a Registered Nurse (RN), physician or both, leading to a sudden drop in staffing levels within the referring department. Remaining staff take on extra roles and responsibilities, potentially increasing risk to patients and staff. Scant research regarding staff members who are ‘left behind’ when an escorted IHT takes place is available. The impact of IHT on staff members with differing levels of experience and the use of decision-making protocols remains largely under explored. Aims This thesis aimed to understand how RNs and physicians of differing experience levels feel when they are left behind due to an IHT occurring, and their perceptions surrounding the decision-making protocols for IHT. Method An exploratory, narrative, qualitative approach that utilised the Lazarus Theory (Lazarus & Folkman, 1984) of Stress and Coping, and the Broaden and Build Theory (Fredrickson, 2004) as a concept theory, was undertaken. Thematic analysis was used to analyse the data. Semi-structured interviews were completed and data analysis utilised NVivo to generate nodes and themes. Findings Five themes were identified: ‘the impact of being left behind’, ‘the burden of transfer’, ‘missed care’, ‘a triangulation of competing needs and the decision-making process’ and ‘the effect of IHT on staff with different levels of experience’. Registered nurse participants with less experience felt the impact of being left behind greater than more experienced RNs. Missed care was of most concern to RNs. Physicians described concern for nursing colleagues and the vulnerability of the department. Providing cover for the hospital Medical Emergency Team and providing IHT escorts for other departments was also of concern to physicians. Conclusion The impact of an escorted IHT on those left behind is of serious concern and is described differently by less experienced RNs compared to their more experienced counterparts. Physicians described the department as vulnerable when an escorted IHT took place. Ad-hoc decision-making protocols are utilised with no evidence to suggest set protocols would be of benefit. Further research into the impact and safety of the removal of staff for IHT on staff and patients who are left behind is required.