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

scholarly journals Health information exchange between hospital and skilled nursing facilities not associated with lower readmissions

2019 ◽  
Vol 54 (6) ◽  
pp. 1335-1345 ◽  
Author(s):  
Dori A. Cross ◽  
Jeffrey S. McCullough ◽  
Jane Banaszak‐Holl ◽  
Julia Adler‐Milstein
Keyword(s):  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing

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 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.

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.

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