Why Better Discharge Communication Between Acute-Care and SNF Nurses is Crucial

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By Carol Davis

Transition of patients from hospital to a skilled nursing facility (SNF) often results in treatment delays, medication errors, and patient harm, but a standardized handoff can improve communication and correct those problems, a new study says.

Systems to improve nurse-to-nurse communication in different handoffs, such as during shift change and unit transfer, are effective in acute-care settings, but efforts to improve communication during the nurse-to-nurse handoff from hospital to SNF have not been widely implemented, according to the study by Wayne State University.

One out of 5 hospitalized patients are discharged to a SNF and are vulnerable and at high risk for functional and clinical decline, making a seamless transition critical, study authors wrote.

Patients’ transfer forms and discharge summaries from hospitals often contain mismatched, missing, inconsistent, and inaccurate information, including patient histories, allergies, instructions for care, and medications lists, the study says.

For example:

  • 22% of the hospital-to-SNF handoffs needed clarification about antibiotic prescriptions
  • 42% of prescriptions for narcotic medications were missing
  • Patients transferred to SNFs had to wait at least 24 hours to receive critical medications

As a result, medication discrepancies increase SNF nurses’ workload and cultivate a “sense of mistrust” of the information received from the hospital, the study says.

Ensuring accurate information

The literature supports the significance of standardizing handoff to ensure clear and accurate information is exchanged, the study says.

For example, effective handoff tools include The SBAR (situation, background, assessment, and recommendation), I-PASS (illness severity, patient information, action list, situational awareness and contingency plans, and synthesis by receiver), and checklists have successfully improved handoff during the shift-to-shift and unit-to-unit report, the study notes.

“These structured communication tools have demonstrated effectiveness in ensuring complete, accurate, and organized patient information is discussed, avoiding confusion and delays, reducing preventable adverse events and medical errors, and encouraging seamless nursing workflow,” the researchers wrote.

However, standardized handoff tools should be developed based on the unit’s needs, the study says.

How the study worked

Before the study began, researchers conducted a one-month chart review of 76 SNF patients, which revealed 56 events of delayed controlled medications and IV antibiotics administration in that month because they were not promptly sent or called into the pharmacy, according to the study.

SNF staff nurses were interviewed about handoff structure and processes and researchers also observed randomly selected hospital-to-SNF handoffs. Data gathered were used to create the standardized handoff tool used in this project. Existing handoff tools were not used because they are not comprehensive enough for SNF needs.

A chart review after the six-week study indicated the wait time of prescriptions availability during the hospital-to-SNF transition was decreased by 79% for controlled medications, with an associated 52.9% reduction in late administration. Wait time for IV antibiotics decreased 94%, with a 77.8% reduction in late administration.

“Handoff communication conveys patient information and transfers the responsibility of care from one nurse to another or from one setting to another,” the study says. “The communication between healthcare settings should pass on important patient information that the receiving facility will utilize to seamlessly continue the patient’s care.”

Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.