Disparate perspectives: Exploring healthcare professionals’ misaligned mental models of older adults’ transitions of care between the emergency department and skilled nursing facility

Older adults’ care transitions remain a significant healthcare quality and patient safety challenge. Care transitions often occur with limited information transfer, poor coordination, and ambiguity about who is responsible for the older adults’ care. Older adults’ care transitions from the Skilled Nursing Facility (SNF), an in-patient sub-acute care setting where patients receive skilled healthcare services such as nursing and physical/occupational/speech therapy, to the ED, and back to the SNF have become a recent focus for quality and safety improvement efforts. 

This study from HIP Investigator Dr. Maureen Smith examined these transitions, and sought to answer the following research questions: 1) What are the mental models of healthcare professionals in the ED and SNF related to older adults’ transitions and 2) to what extent are mental models related to older adults’ transitions shared between the ED and SNF?