Suppose you want to lose five pounds.  What would you do first?  Weigh yourself?  Good idea; this way you can gauge when you’ve reached our goal.

For the same reason, nursing homes that want to reduce unnecessary hospitalizations should first obtain a count of current transfers.  This baseline information will help them measure progress toward their goal.

INTERACT’s Acute Care Transfer Log is designed to help nursing homes track and trend monthly transfers to the hospital and emergency department.  We strongly recommend that one staff person, ideally the INTERACT champion, complete this log every month and bring it to the facility’s quality improvement meetings for discussion.  Only by regularly monitoring transfers can you tell if you are making progress toward your goal.

In our October teleconference call, nursing homes shared how they are using the Acute Care Transfer log:

• Some nursing homes are using the Acute Care Transfer Log to track and trend transfers to the hospital and emergency department.  Other nursing homes are tracking this information electronically using their existing IT system.
• One nursing home pointed out that the log’s usefulness is most apparent after collecting several months of data.  This is especially true when a nursing home transfers relatively few residents (e.g., 3 or so) each month.
• One nursing home retrospectively collected several months of data on transfers as a strategy for conducting root cause analyses before implementing other INTERACT tools.
• A number of nursing homes report using the Quality Improvement Review tool in conjunction with the Acute Care Transfer Log as a strategy for identifying avoidable transfers as well as pinpointing clinical areas that could benefit from improvement.
• One nursing home reported that the log helped the staff identify on-call doctors as one source of unnecessary transfers.  Another nursing home noted that evening hours, as documented on the Acute Care Transfer Log, were high-risk times for avoidable transfers.  Identifying these or similar trends can help nursing home correct common problems.
• A few nursing homes are working with their community hospitals to develop common measures for calculating both a hospitalization rate and a 30-day readmission rate.  One nursing home emphasized that the two rates differ in important ways.  According to this nursing home, hospitals are particularly interested in the latter.  One nursing home reported that its referring hospital has asked the nursing home to include in its 30-day readmission calculation residents who are discharged home from the nursing home but then re-enter the hospital within 30-days of their original hospital discharge date.  INTERACT includes an instruction pamphlet for calculating four different transfer rates.  You can access these instructions online at interact2.net/tools.html.  Scroll down to the very last quality improvement tool: “Measurement of Hospitalization Rates.”