Reducing Avoidable Facility Transfers (RAFT): Outcomes of a Team Model to Minimize Unwarranted Emergency Care at Skilled Nursing Facilities.
Daniel S Stadler, Brant J Oliver, Jennifer G Raymond and 5 others
PMID 31072695WHAT IT FOUND
A team-based model reduced emergency department transfers by 35.8% and hospitalizations by 30.5% in nursing home residents.
Long-term care patients saw the largest drop, with emergency visits falling 61.9%. Post-acute patients showed no significant change in transfers.
Key findings
01Mean monthly emergency department transfers decreased from 24.8 at baseline to 15.9 post-intervention, representing a 35.8% reduction.
02Mean monthly long-term care emergency department transfers reduced from 11.1 at baseline to 4.2 post-intervention, representing a 61.9% reduction.
03Mean monthly emergency department transfers of post-acute care patients did not change significantly post-intervention.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used a pre- and post-intervention design without a control group, so it is not possible to definitively determine effectiveness. Results may not generalize due to the rural setting, academic medical center affiliation, and ethnically homogeneous population. Hospital charges were used as a surrogate for cost, and actual costs or cost-effectiveness were not calculated. The small sample size prevented subgroup analyses or exploration of confounders. National trends in declining hospitalization rates may account for part of the observed reduction.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not assume this model works equally well for all nursing home residents. The study found no significant reduction in emergency transfers or hospitalizations for post-acute care patients, meaning the benefit was concentrated in long-term care residents.