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

> **NIH AHRQ K08** · UNIVERSITY OF WISCONSIN-MADISON · 2020 · $158,220

## Abstract

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.

## Key facts

- **NIH application ID:** 9936305
- **Project number:** 5K08HS025224-03
- **Recipient organization:** UNIVERSITY OF WISCONSIN-MADISON
- **Principal Investigator:** ANGELA M INGRAHAM
- **Activity code:** K08 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $158,220
- **Award type:** 5
- **Project period:** 2018-07-01 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9936305

## Citation

> US National Institutes of Health, RePORTER application 9936305, A Critical Assessment of and Opportunities for Improvement in the Interhospital Transfer of Emergency General Surgery patients (5K08HS025224-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9936305. Licensed CC0.

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