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Reengineering Skilled Nursing Facility Discharge: Analysis of Reengineered Discharge Implementation
Lori L Popejoy1, Bonnie J Wakefield, Amy A Vogelsmeier
1Sinclair School of Nursing, University of Missouri, Columbia (Drs Popejoy, Wakefield, Vogelsmeier and Ms Huneke); Helen Bader School of Social Work, Milwaukee, Wisconsin (Dr Galambos); School of Social Work, Columbia, Missouri (Ms Lewis); Office of Medical Research, University of Missouri, Columbia (Dr Petroski); and Department of Family and Community Medicine, University of Missouri, Columbia (Dr Mehr). Ms Huneke is now with the Family Health Center, Columbia, Missouri.
Background:
There is a need to adopt evidence-based approaches to discharge planning in the skilled nursing facility (SNF) short stay population.
Purpose:
This article describes implementation of the Reengineered Discharge (RED) process in SNFs and makes recommendations for its future implementation.
Methods:
The methods included a pre- and postanalysis of an 18-month RED implementation with a contemporaneous comparison of 4 Midwestern SNFs randomly assigned to 2 different RED implementation strategies. The Standard facilities received less implementation than Enhanced facilities.
Results:
Standard SNFs made more improvements and were more satisfied with the improved process than Enhanced SNFs. Field notes revealed that corporate willingness to make process changes impacted the Standard group's capacity for change; both groups were heavily influenced by external forces, and turnover was an impediment to RED implementation.
Conclusion:
This research revealed that discharge processes are similar across settings and that evidence-based programs such as RED can be adapted to the SNF setting.
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