Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Skilled nursing facilities (SNF) represent a common postdischarge destination for hospitalized older adults. The goals of SNF care include the completion of extended skilled nursing care and physical rehabilitation to enable patients to safely return home. However, nearly one in four older adults discharged to SNF are rehospitalized and one in five seek care in the emergency department (ED) but are discharged back to SNF. ⋯ Of the 1,551,703 Medicare beneficiaries discharged to SNF in 2019, 16.3% had an ED visit within 14 days (n = 253,104). Of those ED visits, 25.5% resulted in a same-day discharge back to SNF (n = 64,472), costing Medicare $24.6 million. Novel care models that can leverage SNF staff and resources while providing rapid diagnostic services are urgently needed.
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De-implementation is the process of reducing or stopping the use of ineffective, harmful, or low-value healthcare services that provide little or no benefit to patients. This article reviews relevant frameworks for planning and evaluating de-implementation initiatives, describes unique barriers, and provides effective strategies for de-implementation in Hospital Medicine.