Table 3.

Potential strategies to overcome barriers to regionalization of adult critical care.

Category	Sub-category	Illustrative quotes
Communication	Continuity of care	I don't think it breaks continuity, as long as the destination facility is in regular communication with the referring facility and communication.
		You need communication back and forth – standardized forms or processes between source and destination that everyone would use.
	Feedback	I think creating a mechanism for timely feedback of the care of those patients will be important.
	Information Technology	Centralized call center for all potential referrals to the main hospital.
		Install the same software program between hospitals so that all records can be transferred electronically. Then you can push the records back and forth between facilities.
Education	Develop and disseminate evidence of benefit	Education of families and of physicians of the need to do this and the benefits to this would be a tremendous asset.
System design	Tier designation based on voluntary service level	It would have to be a mandated criteria for keeping patients at certain seriousness of illness, in order to support a facility that would pass some agency's inspection.
		One solution would be to regionalize different strengths, if for instance, our hospital kept cardiac and CCU capabilities, and sent stroke patients to the other hospital.
	Broad stakeholder participation	EVERYONE would have to be involved.
	Objective triage criteria	Have criteria for what would warrant the patients being transferred. Therefore the doctor wouldn't feel like they failed.
Reimbursement	Feedback revenue to referring centers	Reimbursement rates, so that the hospitals that are doing the transferring can have some reimbursement for the care of those patients.
		Reimburse the sending hospital for at least a portion of the care.
	Transfer patients back to source hospitals after improvement	The patient is appropriately channeled back with the appropriate documentation.
		If people need to have acute rehab, it should be back at the primary unit where the family support is.