Bradley Flansbaum, DO, MPH, MHM

I am going to teach you something you do not know. I am almost sure of it.

Warm handoffs – a term you often hear within the confines of hospital walls when transferring a patient service to service or ward to ward. You do it in-house, but it’s unlikely you make the same connection when you discharge the same patient or transfer them to an outside entity.

But you have to be asleep under a rock not to have heard or read the changes afoot in the skilled nursing facility (SNF) realm, including the rise of the “SNFist”. Too much variation in use and spending; plus, we are learning patients do not need 25 days cooped up in a rehabilitation facility when 15 might do with a segue into home health for another 10 or 14. Patients like being home, and it costs a lot less.

Unfortunately, we do not do SNF handoffs in the same manner as ICUs. Our bad, and inpatient providers better adapt.

As hospitals decant and quality measures get an intimate look in the rehab space, SNFs will notice sicker patients, and the staff there will be more mindful of the sign outs and the data they receive. Know a Centers for Medicare & Medicaid Services value-based program started on October 1 (just like hospitals – penalties and all) and SNFists, whoever they might be – NP/PA/DO/MD – will also require of hospitals a step-up in information transfer, both in quality and timeliness.

Read the full post at hospitalleader.org.

Also on The Hospital Leader

• “Immigration & the Future of Healthcare: Looking to a Greater Good,” by Jordan Messler, MD, SFHM
• “We Must Become Comfortable Talking about Physician Suicide,” by Tracy Cardin, ACNP-BC, SFHM
• “A New Light in the Darkness: Using Hospital-Based Medication-Assisted Treatment to Tackle the Opioid Crisis,” by Richard Bottner, PA-C

I am going to teach you something you do not know. I am almost sure of it.

Warm handoffs – a term you often hear within the confines of hospital walls when transferring a patient service to service or ward to ward. You do it in-house, but it’s unlikely you make the same connection when you discharge the same patient or transfer them to an outside entity.

But you have to be asleep under a rock not to have heard or read the changes afoot in the skilled nursing facility (SNF) realm, including the rise of the “SNFist”. Too much variation in use and spending; plus, we are learning patients do not need 25 days cooped up in a rehabilitation facility when 15 might do with a segue into home health for another 10 or 14. Patients like being home, and it costs a lot less.

Unfortunately, we do not do SNF handoffs in the same manner as ICUs. Our bad, and inpatient providers better adapt.

As hospitals decant and quality measures get an intimate look in the rehab space, SNFs will notice sicker patients, and the staff there will be more mindful of the sign outs and the data they receive. Know a Centers for Medicare & Medicaid Services value-based program started on October 1 (just like hospitals – penalties and all) and SNFists, whoever they might be – NP/PA/DO/MD – will also require of hospitals a step-up in information transfer, both in quality and timeliness.

Read the full post at hospitalleader.org.

Also on The Hospital Leader

• “Immigration & the Future of Healthcare: Looking to a Greater Good,” by Jordan Messler, MD, SFHM
• “We Must Become Comfortable Talking about Physician Suicide,” by Tracy Cardin, ACNP-BC, SFHM
• “A New Light in the Darkness: Using Hospital-Based Medication-Assisted Treatment to Tackle the Opioid Crisis,” by Richard Bottner, PA-C

I am going to teach you something you do not know. I am almost sure of it.

Warm handoffs – a term you often hear within the confines of hospital walls when transferring a patient service to service or ward to ward. You do it in-house, but it’s unlikely you make the same connection when you discharge the same patient or transfer them to an outside entity.

But you have to be asleep under a rock not to have heard or read the changes afoot in the skilled nursing facility (SNF) realm, including the rise of the “SNFist”. Too much variation in use and spending; plus, we are learning patients do not need 25 days cooped up in a rehabilitation facility when 15 might do with a segue into home health for another 10 or 14. Patients like being home, and it costs a lot less.

Unfortunately, we do not do SNF handoffs in the same manner as ICUs. Our bad, and inpatient providers better adapt.

As hospitals decant and quality measures get an intimate look in the rehab space, SNFs will notice sicker patients, and the staff there will be more mindful of the sign outs and the data they receive. Know a Centers for Medicare & Medicaid Services value-based program started on October 1 (just like hospitals – penalties and all) and SNFists, whoever they might be – NP/PA/DO/MD – will also require of hospitals a step-up in information transfer, both in quality and timeliness.

Read the full post at hospitalleader.org.

Also on The Hospital Leader

• “Immigration & the Future of Healthcare: Looking to a Greater Good,” by Jordan Messler, MD, SFHM
• “We Must Become Comfortable Talking about Physician Suicide,” by Tracy Cardin, ACNP-BC, SFHM
• “A New Light in the Darkness: Using Hospital-Based Medication-Assisted Treatment to Tackle the Opioid Crisis,” by Richard Bottner, PA-C

The prevalent reason offered for increased mortality rates during weekend hours are shortages in staffing and services. The “weekend effect,” elucidated by Pauls et al.¹ in their recent meta-analysis, and the accompanying editorial by Quinn and Bell,² highlight these and other potential causes for this anomaly.

Pauls et al.¹ also cite patient selection bias as a possible explanation for the uptick in deaths during this span (off-hour admissions may be sicker). It is due to the latter that we wish to highlight additional studies published after mid-2013 when the authors concluded their search.

Recent disputes within the UK’s National Health Service³ concerning health system funding spurred timely papers in BMJ⁴ and Lancet⁵ on the uncertainty. They both discovered a stronger signal from patient characteristics admitted during this time rather than on-hand resources and workforce. These new investigations strengthen the support for patient acuity as a determinant in explaining worse outcomes.

We highlight these manuscripts so investigators will continue their attempts to understand the weekend phenomena as suggested by both Pauls et al.¹ and the editorialists.² To allow for the delivery of correct interventions, we must understand its root causes. In this case, it may be the unique features of patients presenting on Saturdays and Sundays and, hence, would require a different set of process changes.

Disclosure: The authors declare no conflict of interest.

The prevalent reason offered for increased mortality rates during weekend hours are shortages in staffing and services. The “weekend effect,” elucidated by Pauls et al.¹ in their recent meta-analysis, and the accompanying editorial by Quinn and Bell,² highlight these and other potential causes for this anomaly.

Pauls et al.¹ also cite patient selection bias as a possible explanation for the uptick in deaths during this span (off-hour admissions may be sicker). It is due to the latter that we wish to highlight additional studies published after mid-2013 when the authors concluded their search.

Recent disputes within the UK’s National Health Service³ concerning health system funding spurred timely papers in BMJ⁴ and Lancet⁵ on the uncertainty. They both discovered a stronger signal from patient characteristics admitted during this time rather than on-hand resources and workforce. These new investigations strengthen the support for patient acuity as a determinant in explaining worse outcomes.

We highlight these manuscripts so investigators will continue their attempts to understand the weekend phenomena as suggested by both Pauls et al.¹ and the editorialists.² To allow for the delivery of correct interventions, we must understand its root causes. In this case, it may be the unique features of patients presenting on Saturdays and Sundays and, hence, would require a different set of process changes.

Disclosure: The authors declare no conflict of interest.

The prevalent reason offered for increased mortality rates during weekend hours are shortages in staffing and services. The “weekend effect,” elucidated by Pauls et al.¹ in their recent meta-analysis, and the accompanying editorial by Quinn and Bell,² highlight these and other potential causes for this anomaly.

Pauls et al.¹ also cite patient selection bias as a possible explanation for the uptick in deaths during this span (off-hour admissions may be sicker). It is due to the latter that we wish to highlight additional studies published after mid-2013 when the authors concluded their search.

Recent disputes within the UK’s National Health Service³ concerning health system funding spurred timely papers in BMJ⁴ and Lancet⁵ on the uncertainty. They both discovered a stronger signal from patient characteristics admitted during this time rather than on-hand resources and workforce. These new investigations strengthen the support for patient acuity as a determinant in explaining worse outcomes.

We highlight these manuscripts so investigators will continue their attempts to understand the weekend phenomena as suggested by both Pauls et al.¹ and the editorialists.² To allow for the delivery of correct interventions, we must understand its root causes. In this case, it may be the unique features of patients presenting on Saturdays and Sundays and, hence, would require a different set of process changes.

Disclosure: The authors declare no conflict of interest.