Strategies to Improve Care Transitions Between Nursing Homes and Emergency Departments

Objective: To identify testable solutions that may improve the quality and safety of care transitions between nursing homes (NHs) and emergency departments (EDs). Design: Structured focus group interviews. Setting: Group interviews took place in Indianapolis, Indiana. Participants: NH administrators, nurses, and physicians; emergency medical services directors, paramedics, and emergency medicine technicians; ED nurses and physicians; and a representative from the Indiana State Department of Health. Measurements: Opinions, perceptions, and insights of participants. Results: Eighteen participants were included. The central theme was the need for additional structure to support care transitions between NHs and EDs. Participants agreed that the structure afforded by hospital-to-hospital transfers would benefit patients and providers during transitions between NHs and EDs. Because transfer forms currently vary from NH to NH, participants recommended that the entire state use the same form. They recommended that the transfer form be useful in both directions by including a section for the ED provider to complete to support the ED-to-NH transition. Participants suggested that systems use a transfer checklist to help ensure that all processes occur as expected. They strongly recommended verbal communication across care settings to complement written communication and to improve on deficiencies that occur with transfer form only strategies. Notably, participants suggested that the different care sites engage in relationship-building efforts to improve compliance with recommendations (eg, form completion) and collaborative problem solving. Conclusion: Participants advised additional structure to NH-ED care transitions, similar to hospital-to-hospital transfers, that includes a 2-way, statewide transfer form; a checklist; and verbal communication. (J Am Med Dir Assoc 2011; 12: 602-605)