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Management of Acute Changes in Condition in Skilled Nursing Facilities
Joseph G Ouslander1, Gabriella Engstrom1, Bernardo Reyes1
1Department of Integrated Medical Science, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida.
Journal of the American Geriatrics Society
|November 20, 2018
Summary
Skilled nursing facilities (SNFs) can manage many acute changes in condition without emergency transfers. Most transfers occur for reasons other than the initial change, suggesting non-disease-specific approaches are needed.
Area of Science:
- Gerontology
- Health Services Research
- Nursing Home Care
Background:
- Acute changes in condition are common in skilled nursing facilities (SNFs).
- Unnecessary emergency department (ED) visits and hospitalizations are a significant concern in SNFs.
- Effective management strategies are needed to improve patient outcomes and reduce healthcare costs.
Purpose of the Study:
- To describe the presentation and management of acute changes in condition in SNFs.
- To evaluate the effectiveness of a program designed to reduce unnecessary ED visits and hospitalizations.
- To identify factors associated with hospital transfers for acute changes in condition.
Main Methods:
- Secondary analysis of data from a randomized controlled trial involving 264 SNFs.
- Intervention SNFs received training and support for the Interventions to Reduce Acute Care Transfers program.
- Project champions used a structured online tool to document acute changes in condition.
Main Results:
- Most of the 7,689 reported acute changes in condition were nonspecific and multiple.
- Ten percent of changes resulted in hospital transfer between 72 hours and 7 days.
- Hospital transfers were often for reasons other than the initial acute change.
Conclusions:
- A variety of acute changes in condition can be managed within SNFs, avoiding hospital transfer.
- Nonspecific and multifactorial assessments may be more appropriate than disease-specific protocols for SNF acute changes.
- These findings support the development of tailored management strategies for SNF populations.
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