Abstract
Introduction
Improving hospital discharge processes and reducing adverse outcomes after hospital
discharge to skilled nursing facilities (SNFs) are gaining national recognition. However,
little is known about how the social-contextual factors of hospitals and their affiliated
SNFs may influence the discharge process and drive variations in patient outcomes.
We sought to categorize contextual drivers that vary between high- and low-performing
hospitals in older adult transition from hospitals to SNFs.
Design
To identify contextual drivers, we used a rapid ethnographic approach with interviews
and direct observations of hospital and SNF clinicians involved in discharging patients.
We conducted thematic analysis to categorize contextual factors and compare differences
in high- and low-performing sites.
Setting and Participants
We stratified hospitals on 30-day hospital readmission rates from SNFs and used convenience
sampling to identify high- and low-performing sites and associated SNFs. The final
sample included 4 hospitals (n = 2 high performing, n = 2 low performing) and affiliated
SNFs (n = 5) with 148 hours of observations.
Measures
Central themes related to how contextual factors influence variations in high- and
low-performing hospitals.
Results
We identified 3 main contextual factors that differed across high- and low-performing
hospitals and SNFs: team dynamics, patient characteristics, and organizational context.
First, we observed high-quality communication, situational awareness, and shared mental
models among team members in high-performing sites. Second, the types of patients
cared for at high-performing hospitals had better insurance coverage that made it
feasible for clinicians to place patients based on their needs instead of financial
abilities. Third, at high-performing hospitals a more engaged staff in the transition
process and building rapport with SNFs characterized smooth transitions from hospitals
to SNFs.
Conclusions and Implications
Contextual factors distinguish high- and low-performing hospitals in transitions to
SNF and can be used to develop interventions to reduce adverse outcomes in transitions.
Keywords
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Article info
Publication history
Published online: September 14, 2020
Footnotes
This work was supported by funding from the National Institute on Aging, VA HSR&D Career Development Award and the National Institute of Health Agency for Healthcare Research and Quality.
The funding agency had no role in this study other than providing financial support for study activities. They did not participate in the design, methods, and recruitment of participants, data analysis, or preparation of the article. The views reported are those of the authors and not necessarily those of the National Institutes of Health or VA.
The authors declare no conflicts of interest.
Identification
Copyright
Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
