An interventional study of Intervention to Support Interhospital Transfer Decisions (SITe) in Emergency General Surgery, sponsored by University of Wisconsin, Madison. Terminated at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2024-06-14.
Sponsored by University of Wisconsin, Madison · Not applicable, Interventional, and Health services research
Every year, nearly 240,000 patients age 60 and older are transferred between acute care hospitals for nontraumatic surgical emergencies, and these patients experience worse outcomes than patients admitted directly from an emergency department within a given hospital. Care coordination for older patients with emergency general surgery (EGS) diagnoses suffers because conversations between referring and accepting providers regarding decisions to transfer are ineffective, incomplete, and inefficient. To standardize a method to support transfer decisions that is tailored to older adults within extant transfer processes, the team will (1) engage key stakeholders to develop the intervention to Support Interhospital Transfer Decisions (SITe) for older EGS patients by adapting an existing intervention for interhospital handoffs and (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.
Aim 2 of the protocol qualifies as a clinical trial. Aim 2 will assess the acceptability of the intervention to Support Interhospital Transfer Decisions (SITe), test the feasibility of study procedures, and explore efficacy outcomes for evaluation in a future, larger clinical trial. Modeling a similar and successful pilot, the investigators will conduct a pre (control)/post (intervention) study with 50 transfers in each arm. They will collect pre- and post-intervention data after each eligible transfer through (1) chart review and transfer center logs and (2) Qualtrics surveys of referring and accepting providers. The team will collect baseline (pre) and post-intervention measures of the potential to avoid transfers, efficiency of transfer communication and execution, provider emotional labor, and patient health outcomes. accepting providers will utilize the SITe intervention during calls discussing transfer decisions regarding older emergency general surgery patients. Transfer center nurses and referring providers will be informed of the SITe intervention tool.
The study was terminated early. The research team completed pre-intervention data collection and intervention training. No post-intervention data was collected. As of 3/21/2024, the UW-Madison IRB no longer considers training accepting surgeons on the intervention research.
1,692 studies on the registry are indexed under Emergencies; 333 are open to participants now.
This study's enrollment of 25 is below the median of 145 across 931 interventional studies indexed under Emergencies.
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Exclusion Criteria:
UW Health (accepting) providers will participate in a training to learn how to utilize SITe intervention tools during EGS transfer calls.
Behavioral: Intervention to Support Interhospital Transfer Decisions (SITe)
The SITe intervention and implementation toolkit was developed in Aim 1 through stakeholder activities. SITe, an intervention to support interhospital transfer decisions regarding older EGS patients, includes a checklist and script to be utilized by accepting providers during their conversations with referring providers. The investigators and stakeholders also developed a toolkit for implementation with resources to reduce barriers to and support facilitators of utilizing the tools. The toolkit includes: (1) the checklist and script; (2) methods to train accepting providers on the tools including a PowerPoint presentation and demonstration video; and (3) resources to familiarize other parties (transfer center nurses, referring providers, referring hospitals) with the SITe intervention.
Acceptability of the Intervention to Support Interhospital Transfer Decisions (SITe)
The team will identify 50 study-eligible patient transfers post-intervention training. The team will ask the accepting provider and referring provider who executed the eligible transfer to rate the following statements on a Likert-scale (1=completely disagree to 5=completely agree): * This intervention meets my approval. * This intervention is appealing to me. * I like this intervention. * I welcome this intervention. Acceptability is defined as a minimum average score of 4 per item.
Time frame: 3 months
Fidelity to the Intervention to Support Interhospital Transfer Decisions (SITe)
The team will identify 50 study-eligible patient transfers post-intervention training. The team will measure missingness of the tool elements. Fidelity is defined as \<15% missing patient information.
Time frame: 3 months
Feasibility of Study Procedures
The team will measure the rate of survey completion for study-eligible patient transfers and examine rates of and reasons for missing outcome data.
Time frame: pre-intervention at 3 months, post-intervention at 7 months
Potential to Avoid Transfer: Chart Review
The team will evaluate the quality outcome: potential to avoid transfer. Through chart review, the team will look at number of transfers with no intervention and discharge to home within 72 hours.
Time frame: 7 months
Potential to Avoid Transfer- Second Related Question on Survey - Should Have Been Able
The team will evaluate the quality outcome: potential to avoid transfer. Accepting Providers were asked: "I felt that the referring hospital should have been able to care for the patient." A similar question was not asked of Referring Providers
Time frame: pre-intervention at 3 months, post-intervention at 7 months
Efficiency of Transfer Communication
Following the Relational Model of Organizational Change and through chart review and review of transfer center logs, the team will evaluate the efficiency of transfer communication. The team will review the number of calls required to complete the transfer and time required to complete transfer calls.
Time frame: 7 months
Efficiency of Transfer Execution
The team will evaluate the efficiency of transfer execution. The team will review the time from initial call to patient arrival.
Time frame: 7 months
Emotional Labor - First Related Question on Survey - Respect
Following the Relational Model of Organizational Change and specific Qualtrics questions, the team will evaluate the emotional labor of providers. The team will ask about providers' feelings about being listened to and supported when discussing patient care and difficult patient issues. Question for Referring Providers: I felt respected by the referring provider. Question for Accepting Providers: I felt respected by the UW surgeon.
Time frame: pre-intervention at 3 months, post-intervention at 7 months
Patient Health Outcomes
The team will evaluate patient health outcomes. The team will measure the number of admissions to the emergency department vs inpatient floor, the number of changes in level of patient care (general, intermediate, intensive) within 24 hours of arrival, and the number of adverse events (inpatient mortality, morbidity, extended length of stay.)
Time frame: 7 months
Emotional Labor - Second Related Question on Survey - Listening
Following the Relational Model of Organizational Change and specific Qualtrics questions, the team will evaluate the emotional labor of providers. The team will ask about providers' feelings about being listened to and supported when discussing patient care and difficult patient issues. Question for Referring Providers: The UW Surgeon listened to my concerns about the patient. A similar question was not asked of Accepting Providers
Time frame: pre-intervention at 3 months, post-intervention at 7 months
Emotional Labor - Third Related Question on Survey - Understanding
Following the Relational Model of Organizational Change and specific Qualtrics questions, the team will evaluate the emotional labor of providers. The team will ask about providers' feelings about being listened to and supported when discussing patient care and difficult patient issues. Question for Referring Providers: I felt that the UW Surgeon understood my reason for transfer. A similar question was not asked of Accepting Providers
Time frame: pre-intervention at 3 months, post-intervention at 7 months
Emotional Labor - Fourth Related Question on Survey - Doubt
Following the Relational Model of Organizational Change and specific Qualtrics questions, the team will evaluate the emotional labor of providers. The team will ask about providers' feelings about being listened to and supported when discussing patient care and difficult patient issues. Question for Referring Providers: I felt that the UW Surgeon doubted whether the transfer was necessary. A similar question was not asked of Accepting Providers
Time frame: pre-intervention at 3 months, post-intervention at 7 months
Potential to Avoid Transfer- First Related Question on Survey - Justifiable
The team will evaluate the quality outcome: potential to avoid transfer. Accepting Providers were asked: "I felt that the reason for transfer was justifiable." A similar question was not asked of Referring Providers
Time frame: pre-intervention at 3 months, post-intervention at 7 months
For the intervention training, 9 accepting surgeons were invited to be trained on the transfer tools; 3 accepting surgeons have accepted the invitation and were trained. Six accepting surgeons were invited but did not accept the invitation to complete the training. 25 unique providers took surveys, 3 accepting surgeons trained on the intervention were among them.
| Milestone | Referring Providers | Accepting Providers |
|---|---|---|
| Started | 13 | 12 |
| Providers enrolled in intervention training | 0 | 3 |
| Completed | 13 | 12 |
| Not completed | 0 | 0 |
The team will identify 50 study-eligible patient transfers post-intervention training. The team will ask the accepting provider and referring provider who executed the eligible transfer to rate the following statements on a Likert-scale (1=completely disagree to 5=completely agree): * This intervention meets my approval. * This intervention is appealing to me. * I like this intervention. * I welcome this intervention. Acceptability is defined as a minimum average score of 4 per item.
No measurements were reported for this outcome.
The team will identify 50 study-eligible patient transfers post-intervention training. The team will measure missingness of the tool elements. Fidelity is defined as \<15% missing patient information.
No measurements were reported for this outcome.
The team will measure the rate of survey completion for study-eligible patient transfers and examine rates of and reasons for missing outcome data.
| Surveys | Referring Providers | Accepting Providers |
|---|---|---|
| Pre-Intervention Surveys | 13 | 41 |
| Post-Intervention Surveys | 0 | 0 |
The team will evaluate the quality outcome: potential to avoid transfer. Through chart review, the team will look at number of transfers with no intervention and discharge to home within 72 hours.
No measurements were reported for this outcome.
The team will evaluate the quality outcome: potential to avoid transfer. Accepting Providers were asked: "I felt that the referring hospital should have been able to care for the patient." A similar question was not asked of Referring Providers
| surveys | Accepting Providers - Pre-Intervention |
|---|---|
| Strongly agree | 4 |
| Agree | 12 |
| Neutral | 15 |
| Disagree | 8 |
| Strongly Disagree | 2 |
Following the Relational Model of Organizational Change and through chart review and review of transfer center logs, the team will evaluate the efficiency of transfer communication. The team will review the number of calls required to complete the transfer and time required to complete transfer calls.
No measurements were reported for this outcome.
The team will evaluate the efficiency of transfer execution. The team will review the time from initial call to patient arrival.
No measurements were reported for this outcome.
Following the Relational Model of Organizational Change and specific Qualtrics questions, the team will evaluate the emotional labor of providers. The team will ask about providers' feelings about being listened to and supported when discussing patient care and difficult patient issues. Question for Referring Providers: I felt respected by the referring provider. Question for Accepting Providers: I felt respected by the UW surgeon.
| surveys | Referring Providers Pre-Intervention | Accepting Providers Pre-Intervention |
|---|---|---|
| Strongly disagree | 0 | 0 |
| Disagree | 0 | 2 |
| Neutral | 2 | 5 |
| Agree | 5 | 24 |
| Strongly agree | 6 | 10 |
The team will evaluate patient health outcomes. The team will measure the number of admissions to the emergency department vs inpatient floor, the number of changes in level of patient care (general, intermediate, intensive) within 24 hours of arrival, and the number of adverse events (inpatient mortality, morbidity, extended length of stay.)
No measurements were reported for this outcome.
Following the Relational Model of Organizational Change and specific Qualtrics questions, the team will evaluate the emotional labor of providers. The team will ask about providers' feelings about being listened to and supported when discussing patient care and difficult patient issues. Question for Referring Providers: The UW Surgeon listened to my concerns about the patient. A similar question was not asked of Accepting Providers
| surveys | Referring Providers Pre-Intervention |
|---|---|
| Strongly disagree | 0 |
| Disagree | 1 |
| Neutral | 0 |
| Agree | 5 |
| Strongly agree | 7 |
Following the Relational Model of Organizational Change and specific Qualtrics questions, the team will evaluate the emotional labor of providers. The team will ask about providers' feelings about being listened to and supported when discussing patient care and difficult patient issues. Question for Referring Providers: I felt that the UW Surgeon understood my reason for transfer. A similar question was not asked of Accepting Providers
| surveys | Referring Providers Pre-Intervention |
|---|---|
| Strongly disagree | 0 |
| Disagree | 1 |
| Neutral | 0 |
| Agree | 5 |
| Strongly agree | 7 |
Following the Relational Model of Organizational Change and specific Qualtrics questions, the team will evaluate the emotional labor of providers. The team will ask about providers' feelings about being listened to and supported when discussing patient care and difficult patient issues. Question for Referring Providers: I felt that the UW Surgeon doubted whether the transfer was necessary. A similar question was not asked of Accepting Providers
| surveys | Referring Providers Pre-Intervention |
|---|---|
| Strongly disagree | 8 |
| Disagree | 4 |
| Neutral | 0 |
| Agree | 0 |
| Strongly agree | 1 |
The team will evaluate the quality outcome: potential to avoid transfer. Accepting Providers were asked: "I felt that the reason for transfer was justifiable." A similar question was not asked of Referring Providers
| surveys | Accepting Providers Pre-Intervention |
|---|---|
| Strongly Disagree | 3 |
| Disagree | 4 |
| Neutral | 13 |
| Agree | 13 |
| Strongly agree | 8 |
Collected over Adverse event data were not collected for this study. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| SITe Training for Accepting Providers | — | — | — |
13 unique referring providers completed study survey, 12 unique accepting providers completed study surveys, and 3 accepting providers completed intervention training.
| Age, Continuous(years) | Referring Providers | Accepting Providers | Total |
|---|---|---|---|
| Mean | 45.46 (31 to 68) | 45.4 (36 to 58) | 45.42 (31 to 68) |
| Sex/Gender, Customized(Participants) | Referring Providers | Accepting Providers | Total |
|---|---|---|---|
| Man | 10 | 5 | 15 |
| Woman | 2 | 7 | 9 |
| Non-binary | 0 | 0 | 0 |
| Prefer to self describe | 0 | 0 | 0 |
| Prefer not to say | 1 | 0 | 1 |
| Ethnicity (NIH/OMB)(Participants) | Referring Providers | Accepting Providers | Total |
|---|---|---|---|
| Hispanic or Latino | 1 | 0 | 1 |
| Not Hispanic or Latino | 11 | 12 | 23 |
| Unknown or Not Reported | 1 | 0 | 1 |
| Race (NIH/OMB)(Participants) | Referring Providers | Accepting Providers | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 |
| Asian | 0 | 2 | 2 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 0 | 0 | 0 |
| White | 12 | 10 | 22 |
| More than one race | 0 | 0 | 0 |
| Unknown or Not Reported | 1 | 0 | 1 |
| Region of Enrollment(participants) | Referring Providers | Accepting Providers | Total |
|---|---|---|---|
| United States | 13 | 12 | 25 |
| Profession(Participants) | Referring Providers | Accepting Providers | Total |
|---|---|---|---|
| Physician | 12 | 12 | 24 |
| Advanced Practice Provider (NP, PA) | 0 | 0 | 0 |
| Other | 1 | 0 | 1 |
| Number of years practiced since training was finished(years) | Referring Providers | Accepting Providers | Total |
|---|---|---|---|
| Mean | 12.12 (0 to 32) | 10.2 (1 to 21) | 11.18 (0 to 32) |
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University of Wisconsin, Madison