Implementation of a Skilled Nursing Facility Readmissions Reduction Bundle

Abstract

Readmissions from Skilled Nursing Facilities (SNF) comprised 20% of all readmissions to the project facility. The Revised Iowa Model for Evidence-based Practice, along with rapid-cycle Plan, Do, Study, Act methodology were used to design, implement, and evaluate a readmissions reduction quality improvement project on a general medicine unit within a 130-bed community hospital. A project implementation team was formed and a nurse-led readmissions reduction bundle, accompanying bundle checklist, and Enhanced Care Nurse (ECN) consultations were developed and implemented for five months. The ECN provided consultations both in the inpatient project unit to streamline discharge processes, and in the Emergency Department (ED) in an attempt to avoid inpatient admissions from SNFs. There were 100 inpatient encounters during the course of the project with 14 readmissions from SNFs identified. Run chart methodology was utilized to document and monitor progress and data trends. Project findings included a 6% reduction in SNF readmissions to the project unit during implementation compared to facility readmissions the prior year. Recommendation for improvement includes implementation of the readmissions reduction bundle in all inpatient units that discharge patients within the project facility.