Perspectives of Clinicians at Skilled Nursing Facilities on 30‐Day Hospital Readmissions: A Qualitative Study

• Published in: Journal of hospital medicine 2017-08, Vol.12 (8), p.632-638
• Main Authors: Clark, Bennett W., Baron, Katelyn, Tynan‐McKiernan, Kathleen, Britton, Meredith Campbell, Minges, Karl E., Chaudhry, Sarwat I.
• Format: Article
• Language: English
• Subjects: Aged; Female; Grounded Theory; Humans; Interviews; Interviews as Topic; Male; Patient Care Team - organization & administration; Patient Discharge; Patient Readmission - statistics & numerical data; Patient Transfer - statistics & numerical data; Perception; Prospective Studies; Qualitative Research; Quality Improvement; Skilled Nursing Facilities - organization & administration
• ISSN: 1553-5592; 1553-5606
• DOI: 10.12788/jhm.2785

BACKGROUND Unplanned 30‐day hospital readmissions are an important measure of hospital quality and a focus of national regulations. Skilled nursing facilities (SNFs) play an important role in the readmission process, but few studies have examined the factors that contribute to readmissions from SNFs, leaving hospitalists and other hospital‐based clinicians with limited evidence on how to reduce SNF readmissions. OBJECTIVE To understand the perspectives of clinicians working at SNFs regarding factors contributing to readmissions. DESIGN AND PARTICIPANTS We prospectively identified consecutive readmissions from SNFs to a single tertiary‐care hospital. Index admissions and readmissions were to the hospital's inpatient general medicine service. SNF clinicians who cared for the readmitted patients were identified and interviewed about root causes of the readmissions using a structured interview tool. Transcripts of the interviews were inductively analyzed using grounded theory methodology. RESULTS We interviewed 28 clinicians at 15 SNFs. The interviews covered 24 patient readmissions. SNF clinicians described a range of procedural, technological, and cultural contributors to unplanned readmissions. Commonly cited causes of readmission included a lack of coordination between emergency departments and SNFs, poorly defined goals of care at the time of hospital discharge, acute illness at the time of hospital discharge, limited information sharing between a SNF and hospital, and SNF process and cultural factors. CONCLUSION SNF clinicians identified a broad range of factors that contribute to readmissions. Addressing these factors may mitigate patients' risk of readmission from SNFs to acute care hospitals.