The Consequences of Poor Communication During Transitions from Hospital to Skilled Nursing Facility: A Qualitative Study

Abstract

Background Nurses in skilled nursing facilities (SNFs) play a key role in initiating/transitioning care for the >5 million patients who transition from hospitals-to-SNFs annually. Although hospital discharge processes are well studied, little is known about the SNF nursing processes or the SNF-based consequences of variation in transitional care quality. Objective To examine how SNF nurses transition the care of patients admitted from hospitals, the barriers they experience, and the outcomes associated with variation in the quality of transitions. Design Qualitative study using grounded dimensional analysis, focus groups and in-depth interviews. Setting 5 Wisconsin SNFs. Participants 27 registered nurses. Results SNF nurses rely heavily on written hospital discharge communication to effectively transition patients into the SNF. Nurses cited multiple inadequacies of hospital discharge information, including regular problems with medication orders (including the lack of opioid prescriptions for pain), little patient psychosocial/functional history, and inaccurate information regarding current health status. These communication inadequacies necessitated repeated phone clarifications, created care delays (including delays in pain control), increased SNF staff stress, frustrated patients/family members, directly contributed to negative SNF facility image, and increased a patient's rehospitalization risk. SNF nurses identified a specific list of information/components that they need to facilitate a safe, high-quality transition. Conclusion Nurses note multiple deficiencies in hospital-to-SNF transitions, with poor quality discharge communication being identified as the major barrier to safe and effective transitions. This information should be used to refine and support the dissemination of evidence-based interventions which support transitions of care, including the Interventions to Reduce Acute Care Transfers II (INTERACT) program.

Continuity of Care during Care Transition: Nurses’ Experiences and Challenges

“…Furthermore, municipal nurses experience low quality of discharge communication to be a major threat to patient safety [12]. As in other countries, and regulated by law, routines for discharging and receiving patients across health care levels are framed by cooperation agreements between hospital regions and associated municipalities [13].…”

Improving the process of care setting transitions for adult palliative patients: recommendations for nurse practitioner practice

“…The barriers often emerge as a consequence of the insular and specialized nature of the practice settings themselves. This results in fragmentation in the continuum of care in several discernible areas, and is particularly evident in the disconnection between care facilities or primary care homes (Coleman 2003 ;Parry et al , 2003 ;Rooney & Arbaje, 2012), and in poor patient care plans and discharge or transitional summaries (Council et al , 2012;King et al , 2013;Parry, Kramer, & Coleman, 2006;Parry et al , 2003). Such barriers are also exacerbated by improper medication reconciliation (Kripalani, Jackson, Schnipper, & Coleman, 2007;Meier & Beresford, 2008) and inadequate health information technology (National Transitions of Care Coalition, 2010b).…”

“…Coleman (2003) points out that poor preparation of patients prior to transfer to another care setting leads to increased anxiety and dissatisfaction, which effectively places a greater burden on that patient, as well as the care providers. Additionally, King et al (2013) remind us that untimely transfer of patient care plans and discharge summaries results in care delays leading to unsafe patient care, along with patient and caregiver dissatisfaction.…”

“…Chhabra et al (2012) note that 46%-54% of all preventable adverse drug reactions occur at transition points of care. Above all, poorly executed transitions can lead to re-hospitalization or permanent institutionalization, which, in the context of palliative care, often precipitates a death in a hospital (King et al , 2013 ;Meier & Beresford, 2008). For each decision to transfer, the potential benefit must be weighed against the potential harm.…”

“…Moreover, a number of findings also indicate that both patient care plans and discharge summaries are missing vital information, thereby leading to delays in patient care (Council et al, 2012;King et al , 2013;Parry et al , 2006;Parry et al , 2003). Additionally, practitioners report that discrepancies are routinely found between the oral report given by transferring care settings, and the written report received at the other end (King et al, 2013).…”