Assistant Professor, Department of General Surgery, Prathima Relief Institute of Medical Sciences, Nagunur, Karimnagar, Telangana, India
Relational Coordination, Emergency General Surgery (EGS), Interhospital Transfers, Patient Outcomes, Care Coordination ,

Reliable access to emergency general surgery (EGS) is now largely based on efficient transfer of patients, because many rural hospitals lack trained surgeons. We studied how patient transfers among hospitals in the EGS program affect the results of these transfers. We carried out our study using data from hospital discharges between 2016 and 2018 which involved 150 hospitals and 3,197 patients with direct carotid stent procedures. Our theory was that improved outcomes for patients in intensive care such as reduced death, complications and days in hospital, would be more likely when there were greater numbers of patients shared between hospitals. In total, 35.3% of patients received bad news, including death (3.8%), complications (24.7%) or continued hospitalization (18.7%). Most patients who did not do well after surgery were older, had more illnesses and generally lacked private insurance. Multivariable logistic regression found that greater age in the patient, being assigned male at birth, having multiple disorders and surgical intervention all significantly increased the risk of adverse outcomes. On the other hand, greater patient sharing between hospitals was related to an 15% decrease in the overall odds of adverse events (OR 0.85; 95% CI 0.78–0.92, p<0.001). Patient results were not closely related to hospital bed size or receipt of Disproptionate Share Hospital funds. They demonstrate that shared transfer relationships between hospitals play a key role in making emergency surgical care transfers safer and of better quality. Although previous research aims to refer patients to hospitals that do best, our outcomes show that sticking with well-established transfer paths reduces the chances of running into difficulties. These networks depend in large part on the relational coordination framework and its emphasis on efficient collaboration. The research points out that moving patients across healthcare facilities is complex and requires reliable protocols, especially where there aren’t many doctors to call on

3 , 2 , 2013