Dr. Priscilla Bade
Dr. Bade suggested that one way to improve transfers is to give a limited number of staff at the nursing home password-protected, remote access to the hospital’s electronic medical record system. Allowing such access to Rapid City Regional Hospital records has improved transfer accuracy and completeness, she said. The arrangement requires much interfacility cooperation, said Dr. Bade.
Until technology comes to the rescue at more nursing homes, Dr. Sandvik and Dr. Bade recommended relying on standardized, paper-based forms. The universal transfer form they use at works for transfers of patients not only from the hospital to nursing home but also from surgery to a bed within the hospital, from the intensive care unit to another hospital floor, and from one hospital to another, Dr. Sandvik said.
Some forms, however, "are specific for transfers to specific types of institutions, including skilled nursing facilities, assisted living facilities, home health care agencies," said Dr. Bade. One is specific to patients leaving a nursing home for the hospital emergency department. "These are basically checklists," she said. The forms include medications, other treatments, specific orders, and appointment information and are not valid in South Dakota until signed by a physician.
The nurses also have a separate transfer sheet. "It’s self explanatory, but if it’s not listed, it doesn’t get done," Dr. Sandvik said. "There has to be a reason for each medication given in the nursing home."
An audience member asked if Dr. Bade or Dr. Sandvik experience any pushback on the forms. "Yes, you get pushback," Dr. Sandvik said. "There is more work involved."
"The nursing home transfer forms serve as the discharge orders," Dr. Bade said. "We do have a challenge with them filling out the diagnoses, and we need [to do] more education on that."
Another challenge is adapting to changes in key personnel or facility policies over time. "We are dealing with a moving target," Dr. Sandvik said. Improving the system is an ongoing effort. "Once you have created the perfect transfer process, you will have a perfect transfer process for a very short time."
Dr. Sandvik and Dr. Bade said that they had no relevant disclosures.