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 .