ArticleJournal of the American Geriatrics Society2013
The consequences of poor communication during transitions from hospital to skilled nursing facility: a qualitative study.
Article in Journal of the American Geriatrics Society, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 102 papers, 6 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
102 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Addressing organizational risk factors and interventions during transitions of care for older patients: a systematic umbrella review.BMC health services research · 2026Pooled it
- Models for delivery and co-ordination of primary or secondary health care (or both) to older adults living in aged care facilities.The Cochrane database of systematic reviews · 2024Pooled it
- Healthcare professionals' perspectives and experiences of osteoporosis medication treatment: a qualitative systematic review.Archives of osteoporosis · 2024Pooled it
- Challenges in the Medical and Psychosocial Care of the Paediatric Refugee-A Systematic Review.International journal of environmental research and public health · 2022Pooled it
- Stakeholder perspectives of care for people living with dementia moving from hospital to care facilities in the community: a systematic review.BMC geriatrics · 2019Pooled it
- Family involvement in managing medications of older patients across transitions of care: a systematic review.BMC geriatrics · 2019Pooled it
- Information technology-supported integrated health service for older adults in long-term care settings.BMC medicine · 2024Trial
- Current Psychotropic Medication Use and Contributing Factors Among Nursing Home Residents With Cognitive Impairment.Clinical nursing research · 2021Trial
- Relationship Between Perspective-Taking, Boundary-Crossing Experiences, and Collaborative Practice in Discharge Planning Among Nurses: A Cross-Sectional Study.Japan journal of nursing science : JJNS · 2026Article
- Prolonged Use of Postoperative Gabapentin After Discharge From a Skilled Nursing Facility.Journal of the American Geriatrics Society · 2026Article
- Improving Hospital-to-Skilled Nursing Facility Transitions: Resident-Led Implementation and Evaluation of an EHR-Embedded Discharge Checklist.Joint Commission journal on quality and patient safety · 2026Article
- Restarting Medications After Deprescribing in Adults Discharged From Hospital to Skilled Nursing.JAMA network open · 2026Article
- Surrogate Perspectives on the Communication and Support Processes That Enable Them as Active Decision-Makers Across Chronic Critical Illness.CHEST critical care · 2026Article
- Bridging the Gap: Optimizing OPAT Transitions to Skilled Nursing Facilities.Open forum infectious diseases · 2026Article
- Navigating Postacute Care Options for Patients After Hospital Discharge: A Review.JAMA internal medicine · 2026Review
- Article
- Effects of a post-acute care management program on subsequent acute care utilization for hospitalized patients discharged to skilled nursing facilities.BMC health services research · 2026Article
- 'They Were Talking to Each Other but Not to Me': Examining the Drivers of Patients' Poor Experiences During the Transition From the Hospital to Skilled Nursing Facility.Health expectations : an international journal of public participation in health care and health policy · 2025Article
- A protocol for validation of the Handover Evaluation Scale in multicultural ICUs.Nursing in critical care · 2025Article
- 'You're Just Thinking About Going Home': Exploring Person-Centred Medication Communication With Older Patients at Hospital Discharge.Health expectations : an international journal of public participation in health care and health policy · 2024Article
42 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
objectivesTo examine how skilled nursing facility (SNF) nurses transition the care of individuals admitted from hospitals, the barriers they experience, and the outcomes associated with variation in the quality of transitions.
designQualitative study using grounded dimensional analysis, focus groups, and in-depth interviews.
settingFive Wisconsin SNFs.
participantsTwenty-seven registered nurses. MEASUREMENTS: Semistructured questions guided the focus group and individual interviews.
resultsSNF nurses rely heavily on written hospital discharge communication to transition individuals into the SNF effectively. Nurses cited multiple inadequacies of hospital discharge information, including regular problems with medication orders (including the lack of opioid prescriptions for pain), little psychosocial or functional history, and inaccurate information regarding current health status. These communication inadequacies necessitated repeated telephone clarifications, created care delays (including delays in pain control), increased SNF staff stress, frustrated individuals and family members, contributed directly to negative SNF facility image, and increased risk of rehospitalization. SNF nurses identified a specific list of information and components that they need to facilitate a safe, high-quality transition.
conclusionNurses note multiple deficiencies in hospital-to-SNF transitions, with poor quality discharge communication being identified as the major barrier to safe and effective transitions. This information should be used to refine and support the dissemination of evidence-based interventions that support transitions of care, including the Interventions to Reduce Acute Care Transfers program.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.