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Barriers to regionalization of adult critical care. |
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| Category |
Sub-category |
Illustrative quotes |
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| Patient and Family |
Financial strain |
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. |
| The cost of having to drive 40–50 miles to a tertiary center could be a barrier. |
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| Personal strain |
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 |
General agreement |
I think it would be very difficult to get rural pulmonologists and critical care physicians to participate. |
| I think it is better to cultivate some of the services locally. |
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| Loss of income |
[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 |
[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 |
Loss of income |
If they took all of our sick patients it could be devastating to our facility. |
| Patients equals volume equals financial viability. |
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| Loss of care capacity |
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 |
Overwhelmed resources |
We're full all the time with what we've got. |
| 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 |
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 |
Regulation |
Lack of authority to do any of this. |
| I can't envision a central triage system that would work without controversy. |
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| Cost and cost-effectiveness |
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 |
We basically cannot use all of our beds because of our nursing situation. |
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| Triage and infrastructure |
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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Kahn et al. BMC Health Services Research 2008 8:239 doi:10.1186/1472-6963-8-239 |
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