scholarly journals Discharge Communication of Dementia-Related Neuropsychiatric Symptoms and Care Management Strategies During Hospital to Skilled Nursing Facility Transitions

2020 ◽  
pp. 089198872094424 ◽  
Author(s):  
Andrea L. Gilmore-Bykovskyi ◽  
Melissa Hovanes ◽  
Jacquelyn Mirr ◽  
Laura Block
Keyword(s):  
Neuropsychiatric Symptoms ◽  
Management Strategies ◽  
Skilled Nursing Facility ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Care Needs ◽  
Skilled Nursing ◽  
Poor Outcomes ◽  
Omission Rate ◽  
Discharge Communication

Provided the complexity of managing dementia-related neuropsychiatric symptoms (NPS), accurate communication about these symptoms at hospital discharge is critical to facilitating safe and effective transitions, particularly transitions from hospitals to skilled nursing facilities (SNF), which are often poorly managed. Skilled nursing facilities providers have cited undercommunication regarding NPS as a major challenge that contributes to poor outcomes including rehospitalization. This multisite retrospective cohort study identified omission rates for NPS and associated management strategies in discharge communication as compared to medical record documentation in the 72 hours preceding discharge among hospitalized patients with dementia. High rates of omission were found across NPS and management strategies: anxiety (94%), agitation/aggression (77%), hallucinations (85%), 1:1 supervision (90%), high fall risk (89%), use of restraints (91%). Omission rate for new or modified antipsychotic medication was 12.9%. Findings underscore the need for additional research on cross-setting communication regarding care needs of patients with dementia—who often cannot communicate these needs on their own—in facilitating high-quality transitions.

scholarly journals REDUCING AVOIDABLE FACILITY TRANSFERS: THE RAFT MODEL

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S769-S770
Author(s):  
Daniel Stadler
Keyword(s):  
Medical Center ◽  
Skilled Nursing Facility ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing ◽  
Life Sustaining Treatment ◽  
Acute Care Facilities ◽  
Dartmouth Hitchcock Medical

Abstract Reducing Avoidable Facility Transfers (RAFT) is a Dartmouth-developed program that identifies and honors “what matters most” to patients residing in skilled nursing facilities in a value-based, sustainable way. RAFT aims to reduce avoidable facility transfers of older adults from long-term care and post-acute care facilities to emergency departments (ED). Key components of RAFT presently include (1) systematically eliciting goals of care for all skilled nursing facility residents, (2) translating these goals into orders using the Physician Orders for Life-Sustaining Treatment form, (3) documenting patient wishes about hospitalization, and (4) ensuring that these wishes inform decision-making during acute crises. Data from a pilot program, begun in 2016 with three rural skilled nursing facilities in collaboration with the Dartmouth-Hitchcock Medical Center geriatric practice, showed a 35% reduction in monthly ED transfers, a 30.5% reduction in monthly hospitalizations, and a 50.7% reduction in monthly ED and hospitalization-related charges.

scholarly journals A Case Report in Health Information Exchange for Inter-organizational Patient Transfers

2014 ◽  
Vol 05 (03) ◽  
pp. 642-650 ◽  
Author(s):  
S. Malhotra ◽  
R. Kaushal ◽  
J.E. Richardson ◽  
Keyword(s):  
Case Report ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Skilled Nursing Facility ◽  
Patient Transfer ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Patient Transfers

SummaryObjective: To provide a case report of barriers and promoters to implementing a health information exchange (HIE) tool that supports patient transfers between hospitals and skilled nursing facilities.Methods: A multi-disciplinary team conducted semi-structured telephone and in-person interviews in a purposive sample of HIE organizational informants and providers in New York City who implemented HIE to share patient transfer information. The researchers conducted grounded theory analysis to identify themes of barriers and promoters and took steps to improve the trustworthiness of the results including vetting from a knowledgeable study participant.Results: Between May and October 2011, researchers recruited 18 participants: informaticians, healthcare administrators, software engineers, and providers from a skilled nursing facility. Subjects perceived the HIE tool’s development a success in that it brought together stakeholders who had traditionally not partnered for informatics work, and that they could successfully share patient transfer information between a hospital and a skilled nursing facility. Perceived barriers included lack of hospital stakeholder buy-in and misalignment with clinical workflows that inhibited use of HIE-based patient transfer data. Participants described barriers and promoters in themes related to organizational, technical, and user-oriented issues.The investigation revealed that stakeholders could develop and implement health information technology that technically enables clinicians in both hospitals and skilled nursing facilities to exchange real-time information in support of patient transfers. User level barriers, particularly in the emergency department, should give pause to developers and implementers who plan to use HIE in support of patient transfers.Conclusions: Participants’ experiences demonstrate how stakeholders may succeed in developing and piloting an electronic transfer form that relies on HIE to aggregate, communicate, and display relevant patient transfer data across health care organizations. Their experiences also provide insights for others seeking to develop HIE applications to improve patient transfers between emergency departments and skilled nursing facilities.Citation: Richardson JE, Malhotra S, Kaushal R. A case report in health information exchange for inter-organizational patient transfers. Appl Clin Inf 2014; 5: 642–650http://dx.doi.org/10.4338/ACI-2014-02-CR-0016

Care Management and the Transition of Older Adults From a Skilled Nursing Facility Back Into the Community

2011 ◽  
Vol 12 (2) ◽  
pp. 54-59 ◽  
Author(s):  
Adam G. Golden ◽  
Shanique Martin ◽  
Melanie da Silva ◽  
Bernard A. Roos
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Nursing Care ◽  
Care Management ◽  
Skilled Nursing Facility ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Management Interventions

After hospitalization, many older adults require skilled nursing care. Although some patients receive services at home, others are admitted to a skilled nursing facility. In the current fragmented health care system, hospitals are financially incentivized to discharge frail older adults to a facility for postacute care as soon as possible. Similarly, many skilled nursing facilities are incentivized to extend the posthospitalization period of care and to transition the patient to custodial nursing home care. The resulting overuse of institution-based skilled nursing care may be associated with various adverse medical, social, and financial consequences. Care management interventions for more efficient and effective skilled nursing facility use must consider the determinants involved in the decisions to admit and maintain patients in skilled nursing facilities. As we await health care reform efforts that will address these barriers, opportunities already exist for care managers to improve the current postacute transition processes.

scholarly journals Variation in Employment of Therapy Assistants in Skilled Nursing Facilities Based on Organizational Factors

2020 ◽  
pp. 107755872095257
Author(s):  
Tracy M. Mroz ◽  
Arati Dahal ◽  
Rachel Prusynski ◽  
Susan M. Skillman ◽  
Bianca K. Frogner
Keyword(s):  
Rural Areas ◽  
Skilled Nursing Facility ◽  
Cost Effective ◽  
Organizational Factors ◽  
Skilled Nursing Facilities ◽  
Organizational Characteristics ◽  
Nursing Facilities ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Therapy Services

Employment of therapy assistants enables skilled nursing facilities to provide more therapy services at lower costs. Yet little is known about employment of therapy assistants relative to organizational characteristics. Taking advantage of publicly available Medicare administrative data from 2016, we examined the relationships between organizational characteristics of skilled nursing facilities and employment of therapy assistants. Therapy assistants represent approximately half of the therapy workforce in skilled nursing facilities. Regression analyses indicate significantly higher percentages of therapy assistants are employed in facilities that are staffed by contract therapists, provide more therapy, have more total stays, operate in rural areas, and are located in states with certificate of need laws or moratoria. Skilled nursing facility quality was not significantly associated with employment of therapy assistants. As new payment mechanisms change incentivizes for therapy in skilled nursing facilities, employment of therapy assistants may be a cost-effective way to continue to provide services when necessary.

scholarly journals Residence in Skilled Nursing Facilities Is Associated with Tigecycline Nonsusceptibility in Carbapenem-Resistant Klebsiella pneumoniae

2015 ◽  
Vol 36 (8) ◽  
pp. 942-948 ◽  
Author(s):  
David van Duin ◽  
Eric Cober ◽  
Sandra S. Richter ◽  
Federico Perez ◽  
Robert C. Kalayjian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Susceptibility Testing ◽  
Skilled Nursing Facility ◽  
Positive Culture ◽  
Hospitalized Patients ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Carbapenem Resistant

OBJECTIVETo determine the rates of and risk factors for tigecycline nonsusceptibility among carbapenem-resistant Klebsiella pneumoniae (CRKPs) isolated from hospitalized patientsDESIGNMulticenter prospective observational studySETTINGAcute care hospitals participating in the Consortium on Resistance against Carbapenems in Klebsiella pneumoniae (CRaCKle)PATIENTSA cohort of 287 patients who had CRKPs isolated from clinical cultures during hospitalizationMETHODSFor the period from December 24, 2011 to October 1, 2013, the first hospitalization of each patient with a CRKP during which tigecycline susceptibility for the CRKP isolate was determined was included. Clinical data were entered into a centralized database, including data regarding pre-hospital origin. Breakpoints established by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) were used to interpret tigecycline susceptibility testing.RESULTSOf 287 patients included in the final cohort, 155 (54%) had tigecycline-susceptible CRKPs. Of all index isolates, 81 (28%) were tigecycline-intermediate and 51 (18%) were tigecycline resistant. In multivariate modeling, independent risk factors for tigecycline nonsusceptibility were (1) admission from a skilled nursing facility (OR, 2.51; 95% CI, 1.51–4.21; P=.0004), (2) positive culture within 2 days of admission (OR, 1.82; 95% CI, 1.06–3.15; P=.03), and (3) receipt of tigecycline within 14 days (OR, 4.38, 95% CI, 1.37–17.01, P=.02).CONCLUSIONSIn hospitalized patients with CRKPs, tigecycline nonsusceptibility was more frequently observed in those admitted from skilled nursing facilities and occurred earlier during hospitalization. Skilled nursing facilities are an important target for interventions to decrease antibacterial resistance to antibiotics of last resort for treatment of CRKPs.Infect Control Hosp Epidemiol 2015;36(8):942–948

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