Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May-Jun:45:215-222.
doi: 10.1016/j.gerinurse.2022.04.010. Epub 2022 May 13.

Written discharge communication of diagnostic and decision-making information for persons living with dementia during hospital to skilled nursing facility transitions

Laura Block  1 , Melissa Hovanes  1 , Andrea L Gilmore-Bykovskyi  2
Affiliations

Written discharge communication of diagnostic and decision-making information for persons living with dementia during hospital to skilled nursing facility transitions

Laura Block et al. Geriatr Nurs. 2022 May-Jun.

Abstract

Hospital-to-skilled nursing facility (SNF) transitions constitute a vulnerable point in care for people with dementia and often precede important care decisions. These decisions necessitate accurate diagnostic/decision-making information, including dementia diagnosis, power of attorney for health care (POAHC), and code status; however, inter-setting communication during hospital-to-SNF transitions is suboptimal. This retrospective cohort study examined omissions of diagnostic/decision-making information in written discharge communication during hospital-to-SNF transitions. Omission rates were 22% for dementia diagnosis, 82% and 88% for POAHC and POAHC activation respectively, and 70% for code status. Findings highlight the need to clarify and intervene upon causes of hospital-to-SNF communication gaps.

Keywords: Decision-making; Dementia; Discharge summary; Transitional care.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest The authors report no conflict of interest.

Figures

Figure 1.
Figure 1.
Rates of Omission for Written Communication of Diagnostic and Decision-Making Information across Hospital Record and Discharge Summary
See this image and copyright information in PMC

References

    1. Gleichgerrcht E, Ibáñez A, Roca M, Torralva T, Manes F. Decision-making cognition in neurodegenerative diseases. Nat Rev Neurol. Nov 2010;6(11):611–23. doi: 10.1038/nrneurol.2010.148 - DOI - PubMed
    1. Author & Co-Authors, 2017
    1. Callahan CM, Tu W, Unroe KT, LaMantia MA, Stump TE, Clark DO. Transitions in care in a nationally representative sample of older americans with dementia. Journal of the American Geriatrics Society. Aug 2015;63(8):1495–502. doi: 10.1111/jgs.13540 - DOI - PMC - PubMed
    1. Gaugler JE, Yu F, Davila HW, Shippee T. Alzheimer’s disease and nursing homes. Health affairs (Project Hope). Apr 2014;33(4):650–7. doi: 10.1377/hlthaff.2013.1268 - DOI - PMC - PubMed
    1. Fortinsky RH, Downs M. Optimizing person-centered transitions in the dementia journey: a comparison of national dementia strategies. Health affairs (Project Hope). Apr 2014;33(4):566–73. doi: 10.1377/hlthaff.2013.1304 - DOI - PubMed

Publication types