The issue of poor information sharing between hospitals and nursing homes has been identified as a major problem. The issue regularly contributes to adverse events experienced by nearly 40 percent of nursing home residents within 45 days of hospital discharge. In response to this challenge, the Indianapolis-based Regenstrief Institute has developed a prototype app aimed at improving information exchange and care for patients transitioning from hospitals to nursing homes. This initiative, led by research scientists Kathleen Unroe, M.D., M.H.A., and Joshua Vest, PhD, M.P.H., along with colleagues from Probari, a start-up co-founded by Unroe and Russell Evans, R.N., M.H.A., represents a step in addressing a long-standing issue in patient care.
The details of this innovation were published in the Journal of Post-Acute and Long-Term Care Medicine (JAMDA). The app is specifically designed to meet the needs of nursing home nurses, providing robust, timely, and accessible health record data during the critical transfer phase. What makes this app effective is its compatibility with various electronic medical record systems used by different hospitals and nursing homes, ensuring seamless care transition. It is also compliant with the Fast Healthcare Interoperability Resources (FHIR) standard.Vest, an informatician with a keen interest in both interoperability and social determinants of health, points out the diversity of healthcare institutions and the challenges this poses for information sharing. The app developed by the team addresses this challenge by systematizing the information flow to fit the workflow needs in nursing homes. It also incorporates the sharing of both clinical and social data, considering the overall needs of individuals living in nursing homes.
To develop the app, the researchers conducted surveys with nurses and other stakeholders in multiple nursing homes to understand their information needs and usability requirements. The National Academy of Sciences, Engineering, and Medicine has recognized poor communication between nursing homes and hospitals as a barrier to safe and effective care transitions. The app addresses this issue by ensuring that nursing homes receive comprehensive information about patients, including medical history, medications administered during the hospital stay, cognitive impairments, and living situations prior to hospital admission. The app’s development was supported by a Small Business Innovation Research grant from the National Institutes of Health’s National Institute of Nursing Research. Its performance has been well-received by potential users, and the next step involves developing the prototype into a fully functioning hospital-to-nursing home transfer app. The team plans to test it in real-time with actual transfers to confirm its efficacy in supporting nursing home nurses in admitting patients efficiently and safely, ensuring continuity in the clinical care plan created by the hospital.
This work is positive in the context of older adults’ healthcare, as discharges to skilled nursing facilities (SNFs) constitute a tangible outcome of hospitalizations and emergency department visits. SNF staff often struggle with obtaining relevant and quality information from acute care settings, which is compounded by the variation in the structure and content of discharge summaries from different institutions. An SNF staff-facing transfer application, such as the one developed in this study, promises to improve organizational efficiency, provider satisfaction, and patient safety. The app’s usability was assessed using the System for Usability Scale in standardized patient scenarios with potential end-users. The results showed a mean usability percentile score higher than the established benchmark, indicating acceptable usability. This innovative app has the potential to enhance the quality of information exchange during transitions from acute care to SNFs, addressing a barrier to safe and effective care transitions as identified by the 2022 National Academy of Sciences, Engineering, and Medicine’s report. The successful implementation of such tools could provide a consistent and effective solution for better information sharing in healthcare transitions.