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Implementation of a skilled nursing facility readmission review process.
Mallika L Mendu1,2, Constantinos I Michaelidis3, Michele C Chu1
1Department of Quality and Safety, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
BMJ Open Quality
|August 11, 2018
Summary
Implementing a skilled nursing facility (SNF) readmission review process involving both SNF and hospital perspectives is feasible. This bidirectional review aids in improving patient transitions and reducing preventable readmissions.
Area of Science:
- Healthcare quality improvement
- Patient safety
- Geriatric care
Background:
- 30-day readmissions from skilled nursing facilities (SNFs) to acute care are frequent and often preventable.
- Effective post-acute care transitions are crucial for patient outcomes and healthcare system efficiency.
Purpose of the Study:
- To assess the feasibility and impact of a collaborative SNF readmission review process.
- To identify discrepancies in preventability ratings and contributing factors between SNF and hospital reviewers.
- To facilitate cross-continuum quality improvement initiatives.
Main Methods:
- Implementation of an electronic review tool and monthly conferences for patients readmitted from SNFs.
- Inclusion of 128 patients readmitted within 30 days to a tertiary academic medical center from two partner SNFs.
- Analysis of preventability ratings and contributing factors by both SNF and hospital reviewers.
Main Results:
- Significant discrepancies were observed in preventability ratings between SNF (79.7% not preventable) and hospital (58.6% not preventable) reviewers.
- Moderate positive correlation (rs=0.652, p<0.001) found between SNF and hospital preventability ratings.
- SNF reviewers often cited no contributing factors (57.8%), while hospital reviewers identified end-of-life planning (14.1%) and medical complexity (12.5%) as key issues.
Conclusions:
- A bidirectional SNF readmission review process is feasible and supports systems-based improvements.
- Discrepancies in review highlight opportunities for enhanced communication and standardized assessment in care transitions.
- The process facilitated the development of cross-continuum quality improvement projects to enhance post-acute care.
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