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

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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.