The Effect of Evaluating a Quality Improvement Initiative on Reducing Hospital Transfers of Nursing Home Residents

The Effect of a Quality Improvement Initiative on Reducing Hospital Transfers of Nursing Home Residents by Denise Eileen Jarboe MSN, Walden University, 2010 BS, University of Maryland, 1981 Project Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University February 2015 Abstract Nursing homes (NH) in the 21 century provide skilled healthcare services for resident populations who are older, frailer, and often suffering from multiple incurable chronic medical conditions. Nurses practicing in this setting must be keen observers and effective communicators with the ability to recognize and report subtle changes in health status that may lead to an avoidable or unnecessary hospital transfer. The purpose of this DNP project was to evaluate the impact of a quality assurance performance improvement (QAPI) initiative implementing the INTERACTTM (interventions to reduce acute care transfers) SBAR (situation, background, assessment/appearance, recommendation) communication tool in a skilled NH setting. The Synergy Model, which posits that optimal patient outcomes are possible when nurse competency is matched or synergized with patient care needs, provided the conceptual framework for this project. To evaluate the effect of the program, resident hospital transfer events groups before and after SBAR utilization (n = 295) were analyzed using a dependent t test to determine if significant differences existed in the groups in overall number of transfers, clinical conditionNursing homes (NH) in the 21 century provide skilled healthcare services for resident populations who are older, frailer, and often suffering from multiple incurable chronic medical conditions. Nurses practicing in this setting must be keen observers and effective communicators with the ability to recognize and report subtle changes in health status that may lead to an avoidable or unnecessary hospital transfer. The purpose of this DNP project was to evaluate the impact of a quality assurance performance improvement (QAPI) initiative implementing the INTERACTTM (interventions to reduce acute care transfers) SBAR (situation, background, assessment/appearance, recommendation) communication tool in a skilled NH setting. The Synergy Model, which posits that optimal patient outcomes are possible when nurse competency is matched or synergized with patient care needs, provided the conceptual framework for this project. To evaluate the effect of the program, resident hospital transfer events groups before and after SBAR utilization (n = 295) were analyzed using a dependent t test to determine if significant differences existed in the groups in overall number of transfers, clinical condition categories, and those leading to an inpatient hospitalization. Although analysis of the data did not demonstrate significant decreases in resident transfer events, the results did provide valuable baseline information for future studies. This project contributed to social change by evaluating communication among care providers in a skilled NH setting, establishing baseline information and identifying the need for future projects. This information is vital for determining which resident transfers to the hospital are avoidable and for developing future programs addressing this practice issue. The Effect of Evaluating a Quality Improvement Initiative on Reducing Hospital Transfers of Nursing Home Residents by Denise Eileen Jarboe MS, Walden University, 2010 BS, University of Maryland, 1981 Project Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University February 2015 Dedication Words cannot describe the love and gratitude I have for family and friends who supported me during this journey. To my grandchildren, Paisley and Nolan, for reminding me what is most important for a happy life, and to my husband, Don, for always believing in me and making all things possible. Acknowledgments This project would not have been possible if not for the support and guidance of my professors, mentors, and preceptors. Many thanks to Dr. Kelly Chermack for her editing support; Dr. Cheryl Holly for her constructive advice; Dr. Leslie Hussey for her expertise; Dr. Louis Kaufman for his vision and direction; Susanne Wise-Campbell for graciously sharing her time and insights; and Dr. Alice Conway for her wisdom, encouragement, and motivation to keep going even when things seemed overwhelming. And finally, my heartfelt thanks to Mary Teresa Robinson our program champion, my mentor, preceptor, friend and inspiration for undertaking a project for promoting nursing excellence in a long-term care setting.