Communication Gap Between Hospitals and SNFs Affect Patient Care Transitions

Hospitals don’t appear to be very good at sharing information with skilled nursing facilities during patient transitions.

As reported in an article in JAMA Network Open, a survey of skilled nursing facilities (SNFs) found there are significant shortcomings in the completeness, timeliness, and usability of information provided by hospitals in support of patient transitions.

Julia Adler-Milstein, PhD, Department of Medicine, Center for Clinical Informatics and Improvement Research, University of California, San Francisco, and colleagues suggested these shortcomings are associated with a suboptimal transition experience for patients.

According to the study authors, transitioning between care settings — at any level — involves substantial disruptions that can adversely affect the quality and safety of patient care. Poor information sharing adds to the problem — and these issues are exacerbated in the case of postacute transitions from hospitals to SNFs, since they involve a larger number of high-risk patients with complex health care needs.

In this study, Adler-Milstein and colleagues administered a survey from Jan. 2019 to March 2020 designed to measure the quality of shared information when transitioning patients from hospitals to SNFs and to identify the characteristics associated with optimal information sharing.

The survey was sent to a nationally representative sample of nursing directors from 500 SNFs. Of those, 265 responded, representing 471 hospital-SNF pairs. The survey was designed — based on a 5-point Likert scale — to assess the completeness of information sharing (based on the routine sharing of 23 information types), timeliness (how often information arrived after the patient), and whether the information was usable (i.e., duplicative or extraneous).

About 1 in 7 hospital-SNF pairs (13.5%) reported that information sharing was excellent across all three categories, while 30% reported performance was at or below average in all three.

Regarding completeness of information, missing information typically included behavioral status (67.7%), social status (65.7%), hospital contact information for after-hours questions (53.9%), mental status (44.1%), immunization history (40.7%), functional status/level of independence (35.8%), and information types such as code status and contract information from the discharging physician (20%).

As for timeliness, 16.4% of pairs reported that information was always or often received after the patient arrived, while 33.8% said this occurred sometimes. Usability was also a problem, with almost half (47.1%) reporting that discharge documentation always or often contained duplicative information and 27.8% reporting that this documentation always or often contained extraneous information.

In bivariate analysis, Adler-Milstein and colleagues determined that hospital-SNF pairs were more likely to receive more complete information when:

• They were formally integrated with the hospital (OR, 3.75; 95% CI, 1.62-8.68).
• They were informally integrated (OR, 2.05; 95% CI, 1.40-2.99).
• Had hospital clinicians (OR, 1.74; 95% CI, 1.18-2.57) or care coordinators on site at the SNF (OR, 1.64; 95% CI, 1.10-2.43).
• Had SNF staff on site at the hospital (OR, 1.69; 95% CI, 1.15-2.47).
• When hospital and SNF staff were able to communicate via text (OR, 1.87; 95% CI, 1.17-3.00).

More timely information was associated with having a hospital clinician on site at the SNF (OR, 1.55; 95% CI, 1.05-2.30), while hospital-SNF pairs were less likely to have timely information if SNFs had staff on site at the hospital (OR, 0.59; 95% CI, 0.40-0.87). Hospital accountable care organization participation was associated with more timely information sharing (odds ratio, 1.88; 95% CI, 1.13-3.14).

For usability, the only characteristic associated with no more than one usability challenge was having a hospital clinician on site at the SNF (OR, 1.73; 95% CI, 1.16-2.59; P = 0.02).

Thus, the authors pointed out, having a hospital clinician on site at the SNF was the only characteristic that remained statistically significant and was significant for all three dimensions.

“Given the shortcomings across all three dimensions, our results strongly suggest that hospitals have not sufficiently invested in understanding SNF information needs to support transitional care,” wrote Adler-Milstein and colleagues. They added that their results suggest that having clinicians who can span the two sites of care improves information sharing across all three categories.

“However, broader hospital-led efforts are likely needed, ideally supported by ongoing efforts to improve IT infrastructure and align incentives behind high-quality care transitions,” they concluded.

In a commentary accompanying the study, Andrea Gilmore-Bykovskyi, PhD, RN, University of Wisconsin-Madison, Madison, and colleagues wrote that these results “renew the sense of urgency for expanded mandated hospital discharge summary components.”

“Changes are needed,” they argued, which could include the setting of standards for information continuity. In addition, further research is needed on the longitudinal nature of transitions of care across multiple sites, Gilmore-Bykovskyi and colleagues suggested. “Such a shift can encourage comprehensive, patient-centered solutions for improving information continuity across time and highlight the necessity of research on tools like longitudinal care plans that extend beyond hospital and postacute care settings and evolve with the patient.”

1. There is a communication gap between hospitals and skilled nursing facilities, particularly with regard to the completeness, timeliness, and usability of information communicated by hospitals to skilled nursing facilities during patient transitions.

2. These communication shortcomings could result in suboptimal transition experience for patients.

Michael Bassett, Contributing Writer, BreakingMED™

Cat ID: 728

Topic ID: 498,728,728,791,730,192,925