This quality improvement project implemented a bidirectional apparent cause analysis of patients readmitted to 1 hospital from 8 skilled nursing facilities (SNFs). The purpose of the project was to receive input from both hospital and SNF nursing staff to critically examine the apparent causes of SNF readmissions from both settings and identify opportunities for improvement. Nurse-led measures to prevent readmissions can be found in 5 domains: improved collaboration, communication, coordination, clarification, and cause analysis.
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