How to respond when “turfing” displaces patient welfare


The patient-transfer practice known colloquially as “turfing”—essentially, poorly executed placement decision—has long been problematic and at odds with ethical obligations of quality patient care.

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In a time when physician burnout is rampant, turfing can also negatively affect interprofessional collaboration and physician well-being.

The December issue of AMA Journal of Ethics® (@JournalofEthics) explores the ethical, clinical and legal implications of turfing and how physicians and medical students can proactively and collaboratively approach patient transfers.

The December issue of AMA Journal of Ethics includes the following articles.

  1. How Should Technology-Dependent Patients’ Care Be Managed Collaboratively to Avoid Turfing?

    Technology-dependent inpatients are commonly turfed, either between general services or from subspecialty to general services.

  2. When, If Ever, Is It Appropriate to Regard a Patient as ‘Too Medically Complex’ for One Inpatient Service, But Not Another?

    Constraints on hospitalists and surgeons and restricted orthopaedic admission criteria can exacerbate patients’ distress that comes from physicians’ disagreements.

  3. AMA Code of Medical Ethics’ Opinions Related to ‘Turfing’

    This article summarizes AMA Code guidance about patient transfer practices and discharge planning.

  4. When and How Should Clinicians View Discharge Planning as Part of a Patient’s Care Continuum?

    Safe discharge planning and execution require linkage to follow-up, patient engagement, and multidisciplinary teamwork.

The journal’s December “Ethics Talk” podcast features a discussion with Catherine V. Caldicott, MD, on why turfing gets so little attention in the literature and how physicians can confront turfing when they see it. 

The December issue also features eight author-interview podcasts. Listen to previous episodes of the “Ethics Talk” podcast, or subscribe in Apple Podcasts or other services.

Also, CME modules drawn from this month’s issue are collected at the AMA Ed Hub™ AMA Journal of Ethics webpage.

The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. Submit a manuscript for publication. The journal also invites original photographs, graphics, cartoons, drawings and paintings that explore the ethical dimensions of health or health care.

The next issue of the journal will focus on critical pedagogies in health professions education. Sign up to receive email alerts when new issues are published.