PROJECT ABSTRACT: More than 2.3 million patients experience an interhospital transfer (IHT) each year in the United States. Most IHTs originate from the Emergency Department and neurologic emergencies (NE) are one of the most common reasons for transfer. During IHT, exchange of information and clinician communication are often poor, which may contribute to the associated poorer outcomes compared to patients who are admitted directly to tertiary hospitals. While IHTs have been studied for highly time sensitive conditions including trauma, acute ischemic stroke (AIS), and myocardial infarction, little work has focused on non-AIS NEs, such as hemorrhagic stroke, traumatic intracranial hemorrhage, or seizures. This project seeks to gain an understanding of the IHT process for non-AIS NE by conducting a Failure Modes and Effects and Criticality Analysis (FMECA) to identify, characterize, and rank order the highest risk failures. A select number of identified high risk failures will be targets for the application of human-centered design to develop an intervention. Finally, the applicant will use an implementation framework to implement the intervention and then conduct a feasibility study using a hybrid implementation effectiveness analysis approach to assess both the preliminary effectiveness and the implementation. The overall goal of this project is for the applicant, an emergency medicine physician-scientist, to become a leader in robust methods for risk-assessment of healthcare delivery systems and processes, the application of cutting-edge human-centered design approaches, and implementation science to advance the quality and safety of emergency care while improving patient-centeredness. Under the supervision of primary mentor, S. Prabhakaran, MD, MS, and co-mentors J. Holl, MD, MPH, A. Naidech MD, MSPH, and D. McCarthy, MD, MS, the applicant will leverage the world-class institutional strengths of Northwestern University to improve his skills in risk assessment for healthcare quality and patient safety, human-centered design, implementation science, and prospective study design. With these skills, the applicant will be ideally positioned to become an independent health services and outcomes researcher, focused on the development and testing of novel healthcare delivery interventions in emergency medicine. This proposal combines a highly motivated, exceptionally qualified candidate, an experienced mentorship team, and novel methods to improve the systems and processes of care during the IHT of patients with non-AIS NE, an increasingly common healthcare practice as regionalization of advanced and specialty care increases.

PROJECT NARRATIVE: Interhospital transfer, the process of a patient being moved from one hospital to another for advanced and/or specialized care or patient preference, is occurring more frequently but the current process has many problems. These include poor communication between the doctors, poor communication between doctors and the patient and family, and inconsistent clinical practices. We will use methods from engineering and design to understand the reasons for these problems, get help from doctors, nurses, paramedics, patients, and families to create solutions, and test those solutions in two hospitals.