Project ReEngineered Discharge (RED) lowers hospital readmissions of patients discharged from a skilled nursing facility.

Context: Patients admitted to skilled nursing facilities (SNFs) have a high risk for rehospitalization.

Objective: The goal of this project was to implement Project RED in an SNF to increase patient preparedness for care transitions and lower rehospitalization rates in the 30 days after discharge from the SNF facility.

Design: Intervention study with historical control; phone survey 30 days after discharge from the SNF for data collection.

Team improvement and patient safety conferences: culture change and slowing the revolving door between skilled nursing facility and the hospital.

To improve the safety culture of a skilled nursing facility, we conducted multidisciplinary "Team Improvement for Patient and Safety" (TIPS) case conferences biweekly to identify causes of transfers to acute care hospitals and improvement opportunities. Staff perceptions of organizational patient safety culture were assessed with the Nursing Home Survey on Patient Safety Culture. Over the course of the year, we held 22 TIPS conferences.

Improving disposition outcomes for patients in a geriatric skilled nursing facility.

Objectives: To evaluate an intervention to improve discharge disposition from a skilled nursing unit (SNU).

Design: Historical control comparison of discharge disposition before and after implementation.

Setting: Fifty-bed SNU.