How Hospital Clinicians Select Patients for Skilled Nursing Facilities

Abstract

Background/Objective Hospitalized older adults are frequently transferred to skilled nursing facilities (SNFs) for post-discharge care. Hospitals and SNFs are increasingly held jointly accountable for costs and outcomes of this care. However, it is unclear how clinicians select patients for SNF care; we sought to understand how hospital-based clinicians evaluate older adults in the hospital and decide who will be transferred to a SNF for post-acute care. Design Semi-structured interviews paired with a qualitative analytic approach informed by Social Constructivist theory. Setting Inpatient care units in three hospitals. We used purposive sampling to maximize variability in hospitals, units within hospitals, and staff on those units. Participants Twenty-five clinicians involved in evaluation and decision-making regarding post-acute care, including hospitalists, nurses, therapists, social workers, and case managers. Measurements Central themes related to clinician evaluation and discharge decision-making. Results Clinicians described pressure to expedite evaluation and discharge decisions, resulting in the use of SNF as a “safety net” for older adults being discharged from the hospital. The lack of hospital-based clinician knowledge of SNF care practices, quality, or patient outcomes resulted in the lack of a standardized evaluation process or a clear primary decision-maker. Conclusion Hospital clinician evaluation and decision-making about post-acute care in a SNF may be characterized as rushed, without a clear system or framework for making decisions, and uninformed by knowledge of SNF or patient outcomes in those discharged to SNF. This leads to SNF being used as a “safety net” for many older adults. As hospitals and SNFs are increasingly held jointly accountable for outcomes of patients transitioning between hospital and SNF, novel solutions for improving evaluation and decision-making are urgently needed.

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Geriatrics Literature 2017 Year in Review

“…Burke RE, Lawrence E, Ladebue A et al How Hospital Clinicians Select Patients for Skilled Nursing Facilities. J Am Geriatr Soc 2017;65:2466–2472 …”