Team-based consent with a transfer consent partner to improve emergency department transfer coordination: A quaternary health system pilot.

BACKGROUND: In quaternary academic centers with sustained high demand, level-loading strategies that transfer selected emergency department (ED) admissions to community affiliates can preserve capacity and reduce boarding. In one such system in Portland, Oregon, a mature ED-to-affiliate transfer infrastructure existed; however, consent rates remained low when discussions were largely mediated by ED physicians, limiting transfer execution reliability. OBJECTIVES: To evaluate whether a team-based Transfer Consent Partner model could achieve a consent-to-transfer success rate of at least 75% for ED-to-affiliate hospital transfers. STUDY DESIGN: Single-center quality improvement initiative. METHODS: A Transfer Consent Partner was implemented during a learning launch (November 2025-January 2026) in a quaternary academic ED. The Transfer Consent Partner delivered standardized, emotionally informed consent discussions, addressed patient and family questions, prepared documentation, engaged social work for barriers, and coordinated transfer logistics. The primary outcome was the proportion of Transfer Consent Partner-involved encounters resulting in consent to transfer, with a prespecified target of at least 75%. A secondary analysis compared Transfer Consent Partner-involved encounters with non-Transfer Consent Partner encounters during the concurrent learning-launch period and calculated the absolute difference and its 95% confidence interval. Secondary outcomes included operational demand, temporal distribution, and clinician and patient experience. RESULTS: Over a 12-month evaluation period (February 2025-January 2026), 1909 eligible encounters occurred (overall consent to transfer 40.2%). During the learning launch, 27 of 35 Transfer Consent Partner-involved encounters resulted in consent to transfer (77.1%), meeting the prespecified target. Consent-to-transfer success was 48.3% among concurrent non-Transfer Consent Partner encounters, corresponding to an absolute difference of 28.8 percentage points (95% CI, 12.2 to 40.4). The Transfer Consent Partner supported 1-6 conversations per shift (median 3), lasting 5-40 min (median 10). Physician survey respondents (n = 8) rated teamwork very or extremely strong in 80% of responses. CONCLUSION: In this early learning launch involving 35 Transfer Consent Partner-supported encounters, consent-to-transfer success was higher than among concurrent encounters without Transfer Consent Partner involvement. Broader implementation and evaluation are needed to determine whether these preliminary findings are reproducible and sustainable.