Development and Pilot Testing of an Intervention to Support Interhospital Transfer Decisions (SITe) Regarding Older Adults with Emergency General Surgery Diagnoses

项目摘要 每年有近24万名65岁及以上的病人在急诊科之间转院 以及非创伤性外科急诊医院。这些转移包括紧急普通手术 (EGS)诊断，如肠梗阻、憩室炎和软组织感染。转院病人 经历比那些直接从给定医院内的急诊室入院的人更糟糕的结果。一个促成因素 对于转院的老年EGS患者来说，更糟糕的结果是在医院之间的护理协调受到影响 转账。转移零碎的护理并将老年患者与他们的常规医疗保健提供者分开， 代理决策者和社会支持系统。并存的疾病和急性疾病会限制老年人 成年人提供健康病史和充分参与医疗决策的认知能力。由于 这些威胁，转介和接受提供者之间的沟通对于决定转移老年人至关重要 成年人。然而，首席调查员的数据表明，关于转移决定的对话是不完整的 和不一致，导致护理协调不佳，提供者之间的情绪劳动增加，缺乏 提供商之间就转移决定以及可能避免的转移达成共识。 住院单位之间医院间转移的标准化移交促进了沟通，导致 改善患者护理和预后。同样，规范关于医院间转移的对话 Decision有可能使老年患者受益。为了标准化关于转移决定的沟通， 我们将制定并试行干预措施，以支持特定的医院间转院决策(SITE) 以满足老年EGS患者的需求，并通过以下目标利用现有的转移过程。目标1： 让关键利益相关者参与为老年EGS患者开发现场干预，方法是调整现有的 对医院间交接的干预。目标2：评估现场干预的可接受性，测试 研究程序的可行性，并探索疗效结果，以便在未来更大规模的临床试验中进行评估。 我的长期目标是通过对护理的创新研究来改善老年EGS患者的预后 协调和作为一名独立资助的外科医生、科学家和十字路口临床领导者的职业生涯 EGS和衰老研究。该提案包括一个全面的、量身定制的专业发展计划 它将指导和教育活动与经验研究相结合，这将使我做好准备 在科学和专业方面成为未来以衰老为重点的研究的领导者。我才华横溢的 专门的指导团队由临床医生和研究人员组成，他们是老龄化相关研究的领导者 在护理过渡、医疗提供者之间的沟通和干预发展方面的专业知识。这 提案将产生初步数据，以支持外部的R级临床试验，该试验将有实质性的 随着我们改善提供者之间关于转移老年患者的决定的沟通，这将产生重大影响。

Project Summary Every year, nearly 240,000 patients aged 65 and older are transferred between emergency departments (EDs) and hospitals for non-traumatic surgical emergencies. These transfers include emergency general surgery (EGS) diagnoses such as bowel obstructions, diverticulitis, and soft tissue infections. Transferred patients experience worse outcomes than those directly admitted from EDs within a given hospital. A contributing factor to the worse outcomes of transferred older EGS patients is that care coordination suffers during interhospital transfers. Transfers fragment care and separate older patients from their regular healthcare providers, surrogate decision makers, and social support systems. Comorbid conditions and acute illness can limit older adults’ cognitive capacity to provide their health history and fully participate in medical decision-making. Due to these threats, communication between referring and accepting providers is critical to decisions to transfer older adults. Yet, the Principal Investigator’s data show that conversations about transfer decisions are incomplete and inconsistent, resulting in poor care coordination, increased emotional labor among providers, a lack of consensus between providers about the transfer decision, and potentially avoidable transfers. Standardizing handoffs for interhospital transfers between inpatient units facilitates communication, resulting in improved patient care and outcomes. Similarly, standardizing conversations about interhospital transfer decisions has the potential to benefit older patients. To standardize communication about transfer decisions, we will develop and pilot-test an intervention to Support Interhospital Transfer decisions (SITe) that is specific to the needs of older EGS patients and utilizes extant transfer processes through the following aims. Aim 1: Engage key stakeholders to develop the SITe intervention for older EGS patients by adapting an existing intervention for interhospital handoffs. Aim 2: Assess the acceptability of the SITe intervention, test the feasibility of study procedures, and explore efficacy outcomes for evaluation in a future, larger clinical trial. My long-term goal is to improve outcomes for older EGS patients through innovative research on care coordination and a career as an independently funded, surgeon-scientist and clinical leader at the intersection of EGS and aging research. This proposal includes a comprehensive, tailored Professional Development Plan that combines mentorship and educational activities with experiential research that will prepare me scientifically and professionally to become a future leader in aging-focused research. My talented and dedicated mentoring team consists of clinician-researchers who are leaders in aging-related research with expertise in transitions of care, communication among medical providers, and intervention development. This proposal will produce preliminary data to support an extramural, R-level clinical trial that will have a substantial impact as we improve the communication between providers regarding decisions to transfer older patients.