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Health Care Provider Perspectives on How to Improve Care Transitions Between Hospitals and Skilled Nursing Facilities

Added on October 19, 2017 in Press Releases

View the multimedia news release

(OAKBROOK TERRACE, Illinois, October 19, 2017) – After hospitalization for acute medical illness, one in four Medicare patients is discharged to a skilled nursing facility (SNF). These care transitions are often marked by disruptions in care and poor communication. A new study in the November issue of The Joint Commission Journal on Quality and Patient Safety examines hospital and SNF perspectives on these patient care transitions. 

In the study “Care Transitions Between Hospitals and Skilled Nursing Facilities: Perspectives of Sending and Receiving Providers”—reported by Meredith Campbell Britton, LMSW, research associate, and Sarwat Chaudhry, MD, principal investigator, Yale Center for Healthcare Innovation, Redesign and Learning (CHIRAL), New Haven, Connecticut—qualitative interviews were conducted with 25 hospital providers and 16 SNF providers at three facilities regarding patient transfers and experiences with unplanned hospital readmissions. 

The participants cited challenges with managing increased patient care complexity, identifying an optimal care setting, managing rising financial pressures and overcoming barriers to effective communication. They also identified issues that separate hospital and SNF providers, including SNFs’ reduced physician presence, lower nurse-to-patient ratios, and limited access to pharmacy and equipment services. 

Future interventions, the authors note, “should focus on enhancing communication between clinicians, promoting provider understanding of post-acute care and developing strategic opportunities to align facilities.”

Open access is available to the care transitions article. Also featured in the November 2017 issue:

  • “Examining Racial and Ethnic Differences in Nursing Home Quality”
  • “Time for Nursing Homes to Recognize and Address Disparities in Care”
  • “Use of Unit-Based Interventions to Improve the Quality of Care for Hospitalized Medical Patients: A National Survey”
  • “Root Cause Analysis of ICU Adverse Events in the Veterans Health Administration”
  • “Implementing the Comprehensive Unit-Based Safety Program (CUSP) to Improve Patient Safety in an Academic Primary Care Practice”
  • “Using Fault Trees to Advance Understanding of Diagnostic Errors”
  • “A Scalable Program for Customized Patient Education Videos”
  • “A Novel Process Audit for Standardized Perioperative Handoff Protocols”

For more information, visit The Joint Commission Journal on Quality and Patient Safety website


Note for editors
The article is “Care Transitions Between Hospitals and Skilled Nursing Facilities: Perspectives of Sending and Receiving Providers,” by Meredith Campbell Britton, LMSW; Gregory M. Ouellet, MD; Karl E. Minges, PhD, MPH; Marcie Gawel, MSN, MS, RN; Beth Hodshon, JD, MPH, RN; and Sarwat I. Chaudhry, MD. The article appears in The Joint Commission Journal on Quality and Patient Safety, volume 43, number 11 (November 2017), published by Elsevier.

The Joint Commission Journal on Quality and Patient Safety
The Joint Commission Journal on Quality and Patient Safety (JQPS) is a peer-reviewed journal providing health care professionals with innovative thinking, strategies and practices in improving quality and safety in health care. JQPS is the official journal of The Joint Commission and Joint Commission Resources, Inc. Original case studies, program or project reports, reports of new methodologies or the new application of methodologies, research studies, and commentaries on issues and practices are all considered. 


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