Reducing Preventable Transfers From Short-Stay Care

Friday, 28 July 2017

Carmen Potter, MSN
Chamberlain College of Nursing, Maryland Hts, MO, USA

Reducing Preventable Transfers from Short-Stay Care


Reducing hospital-acquired conditions and decreasing the number of potentially avoidable rehospitalization are targeted goals of the federal health care reform (Maslow & Ouslander, 2012). Vulnerable populations such as clients who are being cared for in skilled nursing facilities (SNF) are often subjected to unnecessary emergency room visits and rehospitalizations. One in 4 clients discharged to a SNF is readmitted within 30 days. (Neuman, Wirtalla, & Werner, 2014).

The PICOT question for the practicum project is, “For the nursing staff on a short-term care unit, does the implementation of an evidence-based patient evaluation tool, INTERACT, lead to a reduction in preventable hospitalizations?”


It is believed that two-thirds of the readmissions are preventable (Neuman, Wirtalla, & Werner, 2014). These interventions increase healthcare costs and the incidences of hospital-acquired complications. Increased morbidity and mortality rates occur as a result of preventable transfers to acute care facilities. If a substantial percentage of rehospitalizations can be prevented, billions of dollars in Medicare and Medicaid savings will result over the next several years (Ouslander, Bonner, Herndon, & Shutes, 2014; Bonner, Tappen, Herndon, & Ouslander, 2014).

Interventions to Reduce Acute Care Transfer (INTERACT) is a quality initiative implemented by many skilled nursing facilities in the United States, Canada, the United Kingdom, and Singapore. Consistent use of the program has been associated with a 24% reduction in preventable hospitalizations of nursing home clients over a six-month period (Ouslander et al., 2014; Toles, Young, & Ouslander, 2013).


Interventions to be implemented at the skilled nursing facility are components of the validated INTERACT quality improvement program. INTERACT is comprised of several tools and does not require implementation of all tools to be effective in reducing preventable transfers to acute care facilities. The INTERACT Quality Improvement Program is designed to assist and guide front-line staff in early identification, assessment, communication, and documentation about acute changes in client condition. It includes clinical and educational tools and strategies for use in everyday practice in skilled nursing facilities. Skilled nursing facilities across the country have implemented portions or all parts of the INTERACT Quality Improvement Program and many facilities have been able to significantly reduce avoidable hospitalizations using these resources (Ouslander et al., 2014; Toles et al., 2013).

The tools chosen for the pilot provide structured information used for client assessment which can then be relayed to the healthcare provider appropriately in a structured format. All licensed nursing staff will use Care Paths. Care Paths is an educational and reference tool used in guiding the nurse with the evaluation of specific symptoms that commonly cause acute care transfers. Acute Change in Condition File Cards are used by licensed nursing staff and provide guidance on when to communicate acute changes in status to healthcare providers. Another tool from the INTERACT program is the Stop and Watch Early Warning Tool which is utilized by Certified Nursing Assistants. Regular evaluation of and recognition of changes in clients’ condition and reporting changes to the nurse is enhanced with use of Stop and Watch. All licensed nursing staff will incorporate the SBAR Communication Tool and Change in Condition Progress Note to effectively evaluate and communicate acute changes in condition to healthcare providers. Documentation of evaluation and communications on the form allows this to be a permanent part of the client medical record. Finally, the fifth INTERACT tool to assist with documentation of unplanned acute care transfers data collection is the Acute Care Transfer Log.

Practice Change

The purpose of the proposed clinical practice change process is to determine if implementing components of the INTERACT program at the skilled nursing facility will reduce preventable transfer and hospitalizations of clients from the short-stay care unit. The project proposal provides an overview of how INTERACT is used to successfully decrease unessential rehospitalizations. Information on the significance of the problem as it relates to a higher than national percentage of rehospitalizations associated with not using a quality program such as INTERACT is presented. Practice recommendations and the plan to implement the proposed change process will be discussed with the goal being preventing unnecessary hospitalizations when it is safe to do so (Maslow & Ouslander, 2012).


Outcome represents results that will be measured to examine the effectiveness of the proposed intervention. Validated outcome measurement tools relevant to the pilot are utilized. The outcome being assessed in the project is the number of avoidable hospital admissions after implementation of the INTERACT quality initiative tools. The long-term objective for the pilot is there will be a 2% decrease in client rehospitalizations from the short-care unit during the eight weeks of practice implementation.