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Tian Y, Ayyappan V, Hemmert K, Myers J, Gitelman Y, Ryskina K. Potentially avoidable emergency department use by patients discharged to skilled nursing facilities. J Hosp Med 2023; 18:524-527. [PMID: 37186454 PMCID: PMC11033682 DOI: 10.1002/jhm.13111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/10/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023]
Abstract
One-third of patients discharged from hospitals to skilled nursing facilities (SNF) are sent back to the Emergency Department (ED) within 30 days. Little is known about those patients who are discharged from the ED directly back to SNF. We considered these ED visits as potentially avoidable since they did not result in observation or hospitalization stay. Using a retrospective chart review of 1010 patients with ED visits within 14-days of discharge to SNF from University of Pennsylvania health system (UPHS) in 2020-2021, we identified 202 patients with potentially avoidable ED visits among medical and surgical patients. The most common reasons for these ED visits were mechanical falls (17.3%), postoperative problems (16.8%), and cardiac or pulmonary complaints (11.4%). Future interventions to decrease avoidable ED visits from SNFs should aim to provide access for SNF patients to receive timely outpatient lab and imaging services and postoperative follow-ups.
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Affiliation(s)
- Ye Tian
- Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Vinay Ayyappan
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Keith Hemmert
- Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer Myers
- Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yevgeniy Gitelman
- Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kira Ryskina
- Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Werner NE, Rutkowski RA, Krause S, Barton HJ, Wust K, Hoonakker P, King B, Shah MN, Pulia MS, Brenny-Fitzpatrick M, Smith M, Carayon P. Disparate perspectives: Exploring healthcare professionals' misaligned mental models of older adults' transitions of care between the emergency department and skilled nursing facility. APPLIED ERGONOMICS 2021; 96:103509. [PMID: 34157478 PMCID: PMC8320066 DOI: 10.1016/j.apergo.2021.103509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/28/2021] [Accepted: 06/13/2021] [Indexed: 06/13/2023]
Abstract
Care transitions that occur across healthcare system boundaries represent a unique challenge for maintaining high quality care and patient safety, as these systems are typically not aligned to perform the care transition process. We explored healthcare professionals' mental models of older adults' transitions between the emergency department (ED) and skilled nursing facility (SNF). We conducted a thematic analysis of interviews with ED and SNF healthcare professionals and identified three themes: 1) ED and SNF healthcare professionals had misaligned mental models regarding communication processes and tools used during care transitions, 2) ED and SNF healthcare professionals had misaligned mental models regarding healthcare system capability, and 3) Misalignments led to individual and organizational consequences. Overall, we found that SNF and ED healthcare professionals are part of the same process but have different perceptions of the process. Future work must take steps to redesign and realign these distinct work systems such that those involved conceptualize themselves as part of a joint process.
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Affiliation(s)
- Nicole E Werner
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States.
| | - Rachel A Rutkowski
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Sheryl Krause
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Hanna J Barton
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Kathryn Wust
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Peter Hoonakker
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Barbara King
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Manish N Shah
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Michael S Pulia
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Maria Brenny-Fitzpatrick
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Maureen Smith
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
| | - Pascale Carayon
- University of Wisconsin-Madison Industrial and Systems, 1513 University Avenue WI Madison, Wisconsin 53706, United States
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