When making decisions about whether to transfer residents to hospital, care home staff consider the possible benefits and risks of different courses of action. However, to date, an in-depth and theoretically informed engagement with these decision-making processes and their associated behaviours has been lacking. We conducted an ethnographic study of care home staff’s decision-making about resident hospital transfers in England between May 2018 and November 2019. We combined staff interviews at six care home sites, with 30 members of staff, with 113 hours of ethnographic observation at three care homes sites. ‘Risk’ and risk management emerged as important overarching themes. In this article we conceptualise staff decision-making about potential hospital transfers for residents as a form of risk work. In doing so, we identify the different forms of risk knowledge that staff used to conceptualise risk and explore the ways staff navigated tensions between different forms of risk knowledge. We highlight the ways individual understandings of risk were influenced by social interactions with others, both at an interpersonal and organisational level, before identifying strategies that staff use to manage risk. By understanding transfer decisions explicitly in terms of the different forms of risk that care home staff manage, our analysis provides new insights into hospital transfers from care homes and contributes to the wider literature around risk work, demonstrating the utility of this concept in researching organisations that fall under the umbrella of social care, which have been previously neglected in academic research.

在决定是否将居民转移到医院时，疗养院的工作人员会考虑不同行动方案可能带来的好处和风险。然而，迄今为止，缺乏对这些决策过程及其相关行为的深入和理论上的知情参与。我们在 2018 年 5 月至 2019 年 11 月期间对英格兰疗养院工作人员关于住院转院的决策进行了人种学研究。我们将六个疗养院地点的员工访谈与 30 名工作人员相结合，在三个护理机构进行了 113 小时的人种学观察家园网站。“风险”和风险管理成为重要的总体主题。在本文中，我们将员工关于住院患者潜在转院的决策概念化为一种风险工作形式。在这样做，我们确定了工作人员用来概念化风险的不同形式的风险知识，并探讨了工作人员在不同形式的风险知识之间驾驭紧张关系的方式。在确定员工用于管理风险的策略之前，我们强调了个人对风险的理解在人际和组织层面受到与他人的社会互动影响的方式。通过明确了解疗养院工作人员管理的不同形式风险的转移决策，我们的分析为从疗养院转院提供了新的见解，并为有关风险工作的更广泛的文献做出了贡献，证明了这一概念在研究组织中的实用性属于以前在学术研究中被忽视的社会关怀的范畴。