(P29) Exploring Factors Driving Hospital Readmissions in Skilled Nursing Facilities

Introduction/Objective: After an acute hospital stay, 1 in 4 patients is transferred to a skilled nursing facility (SNF). Of those, almost 25% are readmitted to the hospital within 30 days. To address the significant financial burden and impact on quality of life, the Protecting Access to Medicare Act of 2014 introduced penalties for SNFs with higher-than-expected readmission rates, which were recently re-implemented. Despite these financial penalties for readmission rates, there is little information on the various factors, especially outside of CMS data, that influence hospital readmissions and why some SNFs excel at maintaining low rates while others do not.

Design/Methodology : We sought to identify the drivers of readmission in SNFs using a positive deviance approach. In-depth qualitative interviews were conducted at 14
SNFs (10 high-performers, 4 low-performers) of varying bed sizes located in the New England, South, and Mid-Western and Pacific regions. We
interviewed 91 clinical and non-clinical personnel using a semi-structured interview guide. Recordings were professionally
transcribed, and themes were identified using the constant comparison method.

Results: Themes related to reduced risk of hospital readmission in SNFs (and related definitions) included: 1) Interdisciplinary Collaboration and Holistic Patient Care; 2) Commitment to Quality Care and Readmission Prevention; 3) Supportive Leadership and Positive Workplace Culture; 4) Investing in Staff Development and Continuous Education; and 5) Community Engagement and Reputation.

Conclusion/Discussion : High-performing SNFs engaged in multifaceted approach to improve quality of care, improve patient outcomes, and create patient-centered environments conducive to reduce hospital readmissions. Whereas, low-performing SNFs were challenged by inconsistent leadership, reliance on agency staff, lack of staff education or support for clinical decision-making (“when it doubt, send out”). Future pilot work focused on bolstering leadership support and workplace culture, as well as quantitative examination of our findings, is warranted.