Sidebar 2.

Interview Guide. Script Used by Interviewer to Elicit Responses from Surgeon Participants

Domain 1: Considerations for transferring patients with acute surgical problems 1Tell me the story of the last patient with an acute surgical problem [for whom you considered transfer to a different facility/who you were asked to accept in transfer]. How did you decide to [transfer or not transfer/accept or not accept] the patient? [Accepting surgeon only] What did you recommend? What guided you as you formulated this recommendation? What did you think would happen with the patient? What happened with that patient? What was the patient and/or family’s response to this? 2Tell me about a similar patient who you felt was very sick. Domain 2: Challenges with patient transfer 3What challenges do you face when [transferring/accepting] very sick patients? How do you decide which patients to [transfer/accept]? How do you manage the challenges of [transferring/accepting] patients? Domain 3: Institutional concerns with patient transfer 4[Referring surgeon only] ]Describe a time when you recommended transfer and the patient and/or family declined. 5[Referring surgeon only] Describe a time when a patient’s care needs exceeded the capabilities of your facility but you did not transfer the patient. 6[Accepting surgeon only] Describe a situation when you were asked to accept a patient in transfer but declined OR felt it would be appropriate to decline. 7[Referring surgeon only] When considering whether to transfer a patient, are there different considerations if you see the patient in the ER versus hospital? Domain 4: Patient and family interactions 8[Accepting surgeon only] What expectations do very sick patients and their families have about their transfers? How do these compare with your expectations/plans for their care? How do you manage differences in expectations? Domain 5: Improving transfers 9What recommendations do you have for improving transfer processes?