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. 2023 Sep 1;4(5):e13022.
doi: 10.1002/emp2.13022. eCollection 2023 Oct.

Transition of care from the emergency department to skilled nursing facility: Retrospective case-control study

Alec P Tolentino  1 , Kelli S Gaus  2 , Yingqiu Gao  3 , Kevin J Chronowski  1 , Jane Helen Brice  1 , Eugenia B Quackenbush  1
Affiliations

Transition of care from the emergency department to skilled nursing facility: Retrospective case-control study

Alec P Tolentino et al. J Am Coll Emerg Physicians Open. .

Abstract

Objective: The primary objective of this study is to describe associations between emergency department (ED)-to-skilled nursing facility (SNF) transition and ED length-of-stay (LOS). The secondary objective is to explore how social determinants of health (SDOH) influence ED-to-SNF transition visit parameters. In 2020, The Centers for Medicare & Medicaid Services issued the "COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers" eliminating the requirement of a 3-day qualifying hospital stay before SNF placement. The waiver allowed ED patients to be transitioned directly to an SNF from the ED.

Methods: We conducted a descriptive retrospective case-control study of adult patients who sought care in the University of North Carolina Hospitals (UNCH) ED between March 1, 2020, and March 1, 2022, lived in a non-SNF residence before their ED visit, and were transitioned directly to an SNF from the ED (n 1 = 27), compared with a group seen in the ED and admitted to hospital for SNF placement (n 2 = 54).

Results: The ED-to-SNF group experienced a significantly longer ED LOS compared to the ED-to-Inpatient-to-SNF group: 72.8 hours (95% confidence interval [CI], 59.2-86.4) compared to 14.5 hours (95% CI, 12.1-16.9). We found no significant differences in SDOH between the ED-to-SNF group and the ED-to-Inpatient-to-SNF group.

Conclusion: Patients who transition from the ED to an SNF experience long ED stays that may adversely affect health and well-being. Transitioning directly from the ED to an SNF may contribute to ED boarding and overcrowding.

Keywords: boarding; crowding; emergency department; length‐of‐stay; nursing home placement; skilled nursing facility.

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Conflict of interest statement

Alec P. Tolentino, Kelli S. Gaus, and Eugenia B. Quackenbush conceived the study, designed the trial and data collection methods, and submitted an institutional review board proposal. Alec P. Tolentino conducted chart review and collected the data, with assistance from Yingqiu Gao. Kelli S. Gaus designed the statistical methods and analyzed the data. Alec P. Tolentino, Kelli S. Gaus, and Eugenia B. Quackenbush drafted the manuscript, and all authors contributed to its revision. Jane Helen Brice provided oversight and advice throughout the duration of the study. Alec P. Tolentino takes responsibility for the article as a whole.The authors declare no conflicts of interest.

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