• Corrie E McDaniel, Kimberly C Arthur, Mary Arakelyan, Cathryn Stevens, Amanda Montalbano, Olutosin Ojugbele, and JoAnna K Leyenaar.
• Department of Pediatrics, University of Washington, Seattle, Washington, USA.
• J Hosp Med. 2022 Apr 1; 17 (4): 268-275.

BackgroundDuring transitions between sites of care, clinicians must build trust with colleagues to make decisions that ensure safe, high-quality care.ObjectivesThis study explored factors that could influence trust between outpatient clinicians and pediatric hospitalists when children are referred for hospital admission.Design, Setting, And ParticipantsWe conducted an analysis of 41 semistructured interviews with outpatient clinicians and pediatric hospitalists from May 2020 through October 2021 across three healthcare systems participating in a multisite comparative effectiveness study of pediatric direct and emergency department admissions.Intervention, Main Outcomes, And MeasuresQualitative interviews. A conceptual model for trust between outpatient clinicians and pediatric hospitalists during hospital admission referral. Interviews were professionally transcribed, verified for accuracy, and analyzed using a combination of inductive and deductive.ResultsWe identified two primary domains: (1) interpersonal trust and (2) trust-by-proxy. Interpersonal trust included five relational factors that influenced collaboration between clinicians: antecedent relationships, confidence in others clinical abilities, understanding others' practice culture, recognition of available resources, and power dynamic. An individual clinicians' assessment of risk and past clinical experiences also influenced trust during clinical decision-making. Trust-by-proxy represented system-level factors that could influence trust, independent of any pre-existing relationships, including communication infrastructure, guidelines and protocols, the organizational culture, and professional courtesy.ConclusionInterpersonal and system-level factors influence trust between outpatient clinicians and hospitalists during decision-making encounters. System-level factors may serve as a proxy for trust when clinicians do not have pre-existing interpersonal relationships. These factors could be explored as an explicit target of interventions to improve interdisciplinary collaboration and decision-making between hospitalists and primary care clinicians.© 2022 Society of Hospital Medicine.

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