Hospital Transfers of Skilled Nursing Facility (SNF) Patients Within 48 Hours and 30 Days After SNF Admission.
Joseph G Ouslander, Ilkin Naharci, Gabriella Engstrom and 5 others
PMID 27349621WHAT IT FOUND
Most skilled nursing facility hospital transfers occurred 30 days or longer after admission, but 8% returned within 48 hours.
Early transfers were commonly linked to abnormal vital signs, altered mental status, shortness of breath, uncontrolled pain, or behavioral symptoms.
Key findings
01Among 4,658 transfers with timing data, 353 (8%) occurred within 48 hours of SNF admission, 524 (11%) occurred 3 to 6 days after admission, 1,450 (31%) occurred 7 to 29 days after admission, and 2,331 (50%) occurred 30 days or longer after admission.
02The most common risk factors identified for transfers within 48 hours and within 30 days were multiple active comorbidities, polypharmacy, CHF, and COPD; the most common signs and symptoms for transfers within 48 hours were abnormal vital signs, altered mental status, shortness of breath, uncontrolled pain, and behavioral symptoms.
03Transfers under 30 days were rated potentially preventable in 25.1% of cases versus 21.5% of transfers 30 days or longer (p = .005), and among preventable transfers staff recognized the condition could have been managed in the SNF with available resources in 25% within 48 hours, 31% under 30 days, and 41% 30 days or longer.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 64 of the 71 actively participating SNFs submitted root cause analysis tools, and facilities were asked to submit as many as they could, with a minimum of four per week if they had that many transfers. The preventability rating was a staff retrospective yes/no judgment, not an external determination. Multiple active comorbidities were recorded, but specific diagnoses were not documented on the tool. Many differences between early and later transfers were small in absolute magnitude. The supplied text does not describe the parent trial's randomisation method.
Declared interests
The supplied text says the work was funded INTERACT research subject to FAU Financial Conflict of Interest Committee terms. The publication types list NIH extramural research support. It does not state that a sponsor designed the study or wrote the manuscript.
The easy way to misread this
Do not read these transfer patterns as evidence that any intervention reduced transfers. The paper describes SNF staff retrospective ratings and associations, not tested treatment effects.