Can I Stay, or Must I Go Now? A Cohort Study of Discharge Appeals in a Post-Acute Skilled Nursing Facility.
W James Deardorff, Grant Tominaga, James D Harrison and 4 others
PMID 41644102WHAT IT FOUND
Thirty-six of 47 SNF patients lost their final discharge appeal, and most patients had notes documenting patient or family concerns about readiness rather than clinician concerns.
Outcome differences were descriptive only.
Key findings
01Forty-seven of 453 eligible short-term SNF admissions appealed discharge; 36 lost their final appeal and 11 won all appeals.
02Most patients had clinical notes documenting patient or family/caregiver concern about discharge readiness rather than clinician concern (28 of 47).
03Descriptive 30-day rehospitalization was 27.8% among patients who lost their final appeal and none among those who won, but the study did not test significance.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Single northern California nonprofit SNF, so results may not apply to other facilities. Only 47 patients appealed, and the study did not compare them with patients who did not appeal. Small sample sizes prevented conclusions about outcome differences between patients who won and lost appeals. The study did not conduct formal statistical significance testing. Functional status was available for only 36 of the 47 patients. Appeal reasons came from electronic health record documentation, which may be incomplete. Rehospitalizations to hospitals outside the linked academic hospital EHR may have been missed.
Declared interests
The supplied text does not state author conflicts of interest. The publication types list NIH extramural research support.
The easy way to misread this
Do not read the 27.8% 30-day rehospitalization rate among patients who lost their final appeal, compared with none among those who won, as proof that losing an appeal causes rehospitalization. The study was small, exploratory, did not test significance, and did not compare patients who appealed with those who did not.