Perspectives of clinicians at skilled nursing facilities on 30-day hospital readmissions: A qualitative study

Bennett W. Clark, Katelyn Baron, Kathleen Tynan-McKiernan, Meredith Campbell Britton, Karl E. Minges, Sarwat I. Chaudhry

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)632-638
Number of pages7
JournalJournal of hospital medicine
Volume12
Issue number8
DOIs
StatePublished - Aug 2017

Bibliographical note

Funding Information:
This research was supported by a grant (#P30HS023554-01) from the Agency for Healthcare Research and Quality (AHRQ) and received support from Yale New Haven Hospital and the Claude D. Pepper Older Americans Independence Center at Yale University School of Medicine (#P30AG021342 NIH/NIA).

Funding Information:
Disclosure: This research was supported by a grant (#P30HS023554-01) from the Agency for Healthcare Research and Quality (AHRQ) and received support from Yale New Haven Hospital and the Claude D. Pepper Older Americans Independence Center at Yale University School of Medicine (#P30AG021342 NIH/NIA).

Publisher Copyright:
© 2017 Society of Hospital Medicine.

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