A Critical Assessment of and Opportunities for Improvement in the Interhospital Transfer of Emergency General Surgery patients

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PROJECT SUMMARY/ABSTRACT Emergency general surgery (EGS) refers to the care of patients with acute, non-traumatic illnesses that may require surgery, such as diverticulitis. Nearly one in five EGS patients is transferred from an emergency department to another hospital for their care. After adjusting for severity of illness, transferred EGS patients experience higher morbidity and mortality than directly admitted patients. However, no organized system exists to facilitate these transfers and potentially improve outcomes. Optimized transfers between hospitals require comprehensive and rapid interorganizational coordination. Evidence-based improvements in the coordination of care between hospitals and rehabilitation facilities have improved outcomes and have the potential to benefit EGS patients transferred between acute care hospitals. Relational Coordination is an established conceptual model to study interorganizational coordination; however, it has not yet been applied to the EGS transfer network and may yield important interventions for improvement in patient outcomes. This project proposes the following aims: 1) Map the current system of interhospital EGS transfers in Wisconsin (WI) to understand the network structure and the association between the “strength of ties” (i.e., number of shared patients) and patient outcomes; 2) Explore the relationships and communication between referring and accepting providers involved in interhospital EGS transfers to better understand how they impact coordination of care; 3) Engage key stakeholders in a statewide collaborative effort to prioritize targets and design an intervention to improve interhospital EGS transfers. Through a mentored research and career development experience, Dr. Ingraham will prepare for a career leading a health services research (HSR) program to study quality of care, practice patterns, and policy evaluation. She will acquire expertise in 1) quantitative network analysis; 2) qualitative research methods; 3) the study of healthcare systems through surgical collaboratives; 4) stakeholder engagement; and 5) responsible conduct of research. As an emergency general surgeon with a master's degree in Clinical Investigation, Dr. Ingraham is uniquely qualified for this work. This proposal fills educational and career development gaps critical to securing independent funding through a multidisciplinary mentored program with experts in network analysis, qualitative research, transitions of care, and Relational Coordination. She is supported by the robust research infrastructure at the University of Wisconsin, where the department of surgery ranks sixth in National Institutes of Health funding and the WI Surgical Outcomes Research Program promotes the collaboration and success of health services researchers. This award meets an urgent public health need while affording the education and mentored research experience critical for Dr. Ingraham to lead an independent research program.