Hospital Transfers of Skilled Nursing Facility (SNF) Patients Within 48 Hours and 30 Days After SNF Admission

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• 作者：Joseph G. Ouslander ; MD^a ; ^b ; ^{Joseph.Ouslander@fau.edu" class="auth_mail" title="E-mail the corresponding author} ; Ilkin Naharci ; MD^a ; ^c ; Gabriella Engstrom ; PhD ; RN^a ; Jill Shutes ; GNP^a ; David G. Wolf ; PhD ; CNHA ; CALA ; CAS^b ; ^d ; Maria Rojido ; MD^a ; Ruth Tappen ; EdD ; RN ; FAAN^b ; David Newman ; PhD^b
• 关键词：Readmissions ; potentially preventable hospitalizations ; skilled nursing facility ; root cause analysis
• 刊名：Journal of the American Medical Directors Association
• 出版年：2016
• 出版时间：1 September 2016
• 年：2016
• 卷：17
• 期：9
• 页码：839-845
• 全文大小：264 K

文摘

Close to 1 in 5 patients admitted to a skilled nursing facility (SNF) are readmitted to the acute hospital within 30 days, and a substantial percentage are readmitted within 2 days of the SNF admission. These rapid returns to the hospital may provide insights for improving care transitions between the acute hospital and the SNF.

Objectives

To describe the characteristics of SNF to hospital transfers that occur within 48 hours and 30 days of SNF admission based on root cause analyses (RCAs) performed by SNF staff, and identify potential areas of focus for improving transitions between hospitals and SNFs.

Design

Trained staff from SNFs enrolled in a randomized, controlled clinical trial of the INTERACT (Interventions to Reduce Acute Care Transfers) quality improvement program performed retrospective RCAs on hospital transfers during a 12-month implementation period.

Setting

SNFs from across the United States.

Participants

64 of 88 SNFs randomized to the intervention group submitted RCAs.

Interventions

SNFs were implementing the INTERACT quality improvement program.

Measures

Data were abstracted from the INTERACT Quality Improvement (QI) tool, a structured, retrospective RCA on hospital transfers.

Results

Among 4658 transfers for which data on the time between SNF admission and hospital transfer were available, 353 (8%) occurred within 48 hours of SNF admission, 524 (11%) 3 to 6 days after SNF admission, 1450 (31%) 7 to 29 days after SNF admission, and 2331 (50%) occurred 30 days or longer after admission. Comparisons between transfers that occurred within 48 hours and within 30 days of SNF admission to transfers that occurred 30 days or longer after SNF admission revealed several statistically significant differences between patient risk factors for transfer, symptoms and signs precipitating the transfers, and other characteristics of the transfers. Hospitalization in the last 30 days and year was significantly more common among those with rapid returns to the hospital. Shortness of breath was significantly more common among those transferred within 48 hours or 30 days, and falls, functional decline, suspected respiratory infection, and new urinary incontinence less common. SNF staff rated a higher proportion of transfers within 30 days versus 30 days or longer as potentially preventable (25.1% vs 21.5%, P = .005). Case descriptions derived from the QI tools of transfers back to the hospital within 48 hours of SNF admission illustrate several factors underlying these rapid returns to the hospital.

Conclusion

RCAs on transfers back to the hospital shortly after SNF admission provide insights into strategies that both hospitals and SNFs can consider in collaborative efforts to reduce potentially avoidable hospital readmissions.