To investigate the current status of surrogate decision-making on the downward referral of stranded patients in the emergency resuscitation room of a tertiary hospital and to analyze its influencing factors, so as to provide a basis for promoting the rational transfer of patients and optimizing the allocation of medical resources.

A total of 330 stranded patients in the emergency resuscitation room of Zhujiang Hospital of Southern Medical University and their surrogate decision-makers were selected as research subjects by convenient sampling from July 2024 to October 2024. Among them,there were 163 male cases (49.4%) and 167 female cases (50.6%), with ages ranging from 30 to 99 years and a mean age of (77.81±12.11) years. For surrogate decision-makers, 164 were males (49.7%) and 166 were females (50.3%), with ages ranging from 23 to 84 years and a mean age of (35.29±11.42) years. According to the scores on the Decision Conflict Scale, the participants were divided into the no decision conflict group (n=125) and the decision conflict group (n=205). A questionnaire survey was carried out with a general information questionnaire, and the decision participation expectation scale and the decision conflict scale, and multiple stepwise linear regression was adopted to analyze the influencing factors.

The decision conflict score of surrogate decision-makers was 31.25 (18.75, 40.62). Multiple stepwise linear regression analysis showed that familiarity with medical institutions, awareness of the hierarchical diagnosis and treatment system, distance between residence and hospital, educational level and relationship with the patient were the main influencing factors, with all differences statistically significant (all P<0.05), which could explain 68.8% of the total variation.

Surrogate decision conflict is common and at a moderate level. Medical staff should strengthen referral information support, health education on the hierarchical diagnosis and treatment system and other measures to reduce decision conflict of surrogate decision-makers and improve decision-making quality.