Improving Interhospital Transfer of Patients with Neurologic Emergencies

More than 2.3 million patients are transferred from one hospital to another, an interhospital transfer (IHT). Most IHT originate from the Emergency Department, and neurologic emergencies (NE) are one of the most common reasons for transfer. Communication during the IHT process is often poor, which may be a major contributor to the poor outcomes that are often associated with undergoing IHT. While IHT in highly time sensitive conditions such as trauma, acute ischemic stroke (AIS) and myocardial infarction have been previously studied, IHT in other conditions has rarely been evaluated. First, Process Mapping and Failure Modes and Effects Analysis will be used to develop a better understanding of the IHT process for non-AIS NE and the high-risk failures. Second, based on the results of the FMECA, the applicant will use user-centered design techniques to develop interventions addressing high-risk failures. Finally, the applicant will conduct a pilot feasibility trial of these interventions. The overall goal of this project is for the applicant, an emergency physician, to become a leader in cutting edge intervention design techniques to improve the quality and safety of care for emergency department patients 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, user centered design, implementation science and prospective study design. With these skills, the applicant will be ideally positioned to become an independent health services researcher, focused on the development and testing of tools and novel interventions to improve patient-centered outcomes of emergency care while reducing costs and unnecessary care. This proposal combines a highly motivated, exceptionally qualified candidate, an experienced mentorship team, and novel methods to improve processes of care in the IHT of patients with non-AIS NE, an increasingly common process as care becomes more regionalized and specialty care becomes in greater demand.