Bridging the Hospital-Skilled Nursing Facility Information Continuity Divide
Authors: Andrea Gilmore-Bykovskyi, Laura Block, Amy J. H. Kind
Journal: JAMA Network Open (2021)

There is a communication chasm between most hospitals and skilled nursing facilities (SNFs), one that often remains invisible to many hospital-based clinicians and often negatively impacts patient experience, satisfaction, and health outcomes.Hospital settings provide the lions' share of clinician training in the US health care system, whereas SNF settings are rarely encountered in standard health professional training pathways.This lack of awareness, coupled with a number of other clinician, policy, and system factors, conspires to create our current reality in which hospital clinicians are regularly blind to the unique challenges of SNF environments.In a SNF, patient acuity approaches that of a hospital, medical clinicians and pharmacists are not regularly on site, and staff nurses face patient ratios much larger than those in hospital settings.Information quality and flow between hospitals and SNFs at the point of hospital discharge are notoriously poor and delayed.Solutions to information continuity have been slow in coming and often neglect the real-world practical constraints of the SNF setting.The SNF simply does not have the extra resources, time, or staffing to span the breadth of this communication chasm.Bridge building between these settings must proceed from both ends of the gulf.Adler-Milstein and colleagues 1 provide an important contribution to this debate by presenting their findings from the first nationally representative survey of SNFs on this topic.Unfortunately and disappointingly, their survey demonstrated continued widespread inadequacies of information communication during transitions from hospitals to SNFs. 1 Despite broader adoption of electronic health records (EHRs) and gains in interoperability resultant from the Health Information Technology for Economic and Clinical Health Act over recent years, continued severe inadequacies in the flow and quality of essential information remain. 1 The study applied sound survey methods to address both medical and nonmedical communication domains essential to the needs of SNF patients, particularly those with cognitive and functional impairments.The gaps in information continuity were exceedingly common and multidimensional, reflecting omissions, delays, inconsistencies, redundancies, and poor usability, with nearly one-half of SNFs citing important information arriving well after the patient. 1 Because the study sampled well-established SNF-hospital pairs and surveyed directors of nursing who may have varied direct involvement in transitions, it is likely that the reported findings are underestimates, the proverbial tip of the iceberg.We know from prior studies 2 that adverse patient outcomes, such as 30-day readmissions, are associated with poor quality information communication during hospital-to-SNF transitions.However, Adler-Milstein and colleagues 1 provide evidence of marked information gaps that likely are associated with both patient and SNF staff-specific outcomes.Prior studies 2 have found that nursing staff, the primary workforce in SNF environments, encounter significant added strain and burden as a result of poor hospital-to-SNF information continuity.The consequences of poor communication may also differentially impact highly vulnerable populations, such as the large number of SNF