Nursing Home, Hospital Transitions Hurt by Lax Application of Best Practice Protocols

Hospital discharge to skilled nursing facilities can benefit from certain protocols that are currently missing when patients make this transition between care settings, according to a new study.

While the complexity of care transitions between nursing homes and hospitals is well known, investments in programs like Age Friendly Health Systems (AFHS) have become key to ensuring continuity of knowledge and practices across care settings.

However, it appears efforts to implement AFHS in hospitals and care settings accessed by older adults has been lacking, a study published in JAMDA suggests. Specifically, there needs to be more focus, more resources and attention on hospital-SNF transitions if AFHS is to work the way it was intended.

Three near-term opportunities were identified in the JAMDA study: hospitals using preferred SNF partnerships to promote continuity, a broader strategy to develop a discharge plan focused on AFHS’s “4Ms,” and hospitals investing in local training programs for post-acute care facilities focused on the 4Ms and 4Ms during transitions.

Care settings have been slow to pick up the program’s 4Ms framework, which stands for What Matters, Medication, Mentation and Mobility, the study’s authors said. And, these protocols have not been appropriately adopted across multiple health care settings.

To reach their conclusions, researchers conducted five interviews at three health systems, all of which implemented the 4Ms in an inpatient setting. Deprescribing high-risk medications and understanding an individual’s clinical trajectory developed from an inpatient stay were some of the challenges identified in interviews, the authors said.

“For example, in the hospital setting, Mobility initiatives often focus on maintaining prior levels of mobility while recovering from acute illness or injury,” the authors noted. “In contrast, in the post-acute care setting, Mobility initiatives may focus on reestablishing baseline levels of mobility to determine new physical and social needs for the older adult.”

AFHS was developed by the John A. Hartford Foundation and Institute for Healthcare Improvement, in partnership with the American Hospital Association and Catholic Health Association of the United States.

Setting-specific implementation of the 4Ms framework misses opportunities to support care transitions for older adults, the study found. SNFs should partner with hospitals who have tailored the 4Ms to transitional care activities, ensuring that such practices can be continued in the SNF setting.

“While very exciting to see that hospitals and, separately SNFs, are investing in the 4Ms, those efforts will be directly limited if they don’t partner to ensure continuity of 4Ms care practices across care settings,” Julia Adler-Milstein, co-author of the study, said in an email to Skilled Nursing News.

While not uncommon, Adler-Milstein said it was surprising that organizations continue to focus and invest so heavily on efforts within their “four walls.” She’d like to see both care settings spend time and energy on figuring out how to continue and extend patient benefits during a care transition, “given how frequent these transitions are.”

Adler-Milstein, Grace Kreuger, Sarah Rosenthal and Dr. Stephanie Rogers were involved in the AFHS report.