Evaluation of the Skilled Nursing Facility (SNF) Transitional Care Management Program (TCMP) Using Decision Support on Post-Acute Discharge SNF Length of Stay and Subsequent Hospital Readmissions

2019 ◽  
Vol 20 (3) ◽  
pp. B27-B28
Author(s):  
Charles T. Pu ◽  
C.T. Pu ◽  
Y. Gao ◽  
S. Garrels ◽  
M. Vestal ◽  
...  
Keyword(s):  
Decision Support ◽  
Length Of Stay ◽  
Care Management ◽  
Transitional Care ◽  
Hospital Readmissions ◽  
Skilled Nursing Facility ◽  
Management Program ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Care Management Program

Progressive Mobility As a Team Effort in Transitional Care

2015 ◽  
Vol 35 (3) ◽  
pp. 62-68 ◽  
Author(s):  
Margaret M. Ecklund ◽  
Jill W. Bloss
Keyword(s):  
Hospital Readmission ◽  
Transitional Care ◽  
Interdisciplinary Collaboration ◽  
Skilled Nursing Facility ◽  
Care Program ◽  
Care Needs ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Core Culture ◽  
The Continuum

With changing health care, progressive care nurses are working in diverse practice settings to meet patient care needs. Progressive care is practiced along the continuum from the intensive care unit to home. The benefits of early progressive mobility are examined with a focus on the interdisciplinary collaboration for care in a transitional care program of a skilled nursing facility. The program’s goals are improved functional status, self-care management, and home discharge with reduced risk for hospital readmission. The core culture of the program is interdisciplinary collaboration and team partnership for care of patients and their families.

Project ReEngineered Discharge (RED) Lowers Hospital Readmissions of Patients Discharged From a Skilled Nursing Facility

2013 ◽  
Vol 14 (10) ◽  
pp. 736-740 ◽  
Author(s):  
Randi E. Berkowitz ◽  
Zachary Fang ◽  
Benjamin K.I. Helfand ◽  
Richard N. Jones ◽  
Robert Schreiber ◽  
...  
Keyword(s):  
Hospital Readmissions ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing

scholarly journals Connect-Home: Transitional Care of Skilled Nursing Facility Patients and their Caregivers

2017 ◽  
Vol 65 (10) ◽  
pp. 2322-2328 ◽  
Author(s):  
Mark Toles ◽  
Cathleen Colón-Emeric ◽  
Mary D. Naylor ◽  
Josephine Asafu-Adjei ◽  
Laura C. Hanson
Keyword(s):  
Transitional Care ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing

A Multifactorial Intervention Reduces 14 and 30 Day Hospital Readmissions from a Skilled Nursing Facility

2013 ◽  
Vol 14 (3) ◽  
pp. B13
Author(s):  
Emily R. Downing ◽  
Emily R. Downing ◽  
Neal Buddensiek ◽  
Peter Sandgren ◽  
Karen Tomes ◽  
...  
Keyword(s):  
Hospital Readmissions ◽  
Skilled Nursing Facility ◽  
Day Hospital ◽  
Multifactorial Intervention ◽  
Nursing Facility ◽  
Skilled Nursing

Impact of Comprehensive Nurse-Managed Transitional Care

2001 ◽  
Vol 10 (3) ◽  
pp. 295-313 ◽  
Author(s):  
Ruth M. Tappen ◽  
Rosemary F. Hall ◽  
Susan L. Folden
Keyword(s):  
Daily Living ◽  
Transitional Care ◽  
Comparison Group ◽  
Skilled Nursing Facility ◽  
Design Data ◽  
Nursing Facility ◽  
Care Environment ◽  
Skilled Nursing ◽  
Quasi Experimental

The purpose of this study was to test the effectiveness of nurse-managed transitional care on the quality of care and functional ability of individuals following discharge from subacute units. Registered nurses employed on subacute units in a skilled nursing facility provided the nurse-managed transitional care. Using a quasi-experimental design, data were collected on admission to the subacute unit, at the time of discharge, 1 week following discharge, and 3 months following discharge on 242 treatment and comparison participants. The treatment group participants' overall function and quality of the care environment were significantly higher than the comparison group at 1 week and 3 months following discharge. Participants did not differ significantly on basic activities of daily living or number of readmissions.

scholarly journals Transitional Care Outcomes in Veterans Receiving Post‐Acute Care in a Skilled Nursing Facility

2019 ◽  
Vol 67 (9) ◽  
pp. 1820-1826 ◽  
Author(s):  
Robert E. Burke ◽  
Anne Canamucio ◽  
Thomas J. Glorioso ◽  
Anna E. Barón ◽  
Kira L. Ryskina
Keyword(s):  
Acute Care ◽  
Transitional Care ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Care Outcomes ◽  
Post Acute Care
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