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

Authors

  • Barbara J. King PhD, RN,

    Corresponding author
    • School of Nursing, University of Wisconsin at Madison, Madison, Wisconsin
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  • Andrea L. Gilmore-Bykovskyi MS, RN,

    1. School of Nursing, University of Wisconsin at Madison, Madison, Wisconsin
    2. Geriatric Division, School of Medicine and Public Health, University of Wisconsin at Madison, Madison, Wisconsin
    3. Health Innovation Program, University of Wisconsin at Madison, Madison, Wisconsin
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  • Rachel A. Roiland PhD, RN,

    1. School of Nursing, University of Wisconsin at Madison, Madison, Wisconsin
    2. William S. Middleton Memorial Veterans Hospital Geriatric Research Education and Clinical Center, Madison, Wisconsin
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  • Brock E. Polnaszek BS,

    1. Geriatric Division, School of Medicine and Public Health, University of Wisconsin at Madison, Madison, Wisconsin
    2. Health Innovation Program, University of Wisconsin at Madison, Madison, Wisconsin
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  • Barbara J. Bowers PhD, RN,

    1. School of Nursing, University of Wisconsin at Madison, Madison, Wisconsin
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  • Amy J. H. Kind MD, PhD

    1. Geriatric Division, School of Medicine and Public Health, University of Wisconsin at Madison, Madison, Wisconsin
    2. Health Innovation Program, University of Wisconsin at Madison, Madison, Wisconsin
    3. William S. Middleton Memorial Veterans Hospital Geriatric Research Education and Clinical Center, Madison, Wisconsin
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Address correspondence to Barbara J. King, School of Nursing, University of Wisconsin at Madison, H6/246 CSC, 600 Highland Avenue, Madison, WI 53792. E-mail: bjking2@wisc.edu

Abstract

Objectives

To examine how skilled nursing facility (SNF) nurses transition the care of individuals 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

Five Wisconsin SNFs.

Participants

Twenty-seven registered nurses.

Measurements

Semistructured questions guided the focus group and individual interviews.

Results

SNF nurses rely heavily on written hospital discharge communication to transition individuals into the SNF effectively. Nurses cited multiple inadequacies of hospital discharge information, including regular problems with medication orders (including the lack of opioid prescriptions for pain), little psychosocial or functional history, and inaccurate information regarding current health status. These communication inadequacies necessitated repeated telephone clarifications, created care delays (including delays in pain control), increased SNF staff stress, frustrated individuals and family members, contributed directly to negative SNF facility image, and increased risk of rehospitalization. SNF nurses identified a specific list of information and 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 that support transitions of care, including the Interventions to Reduce Acute Care Transfers program.

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