Decreasing Nursing Home Readmissions Using the Stop and Watch Early Warning Tool

Abstract

Background: Nursing home (NH) residents are at high risk for hospitalization. One successful initiative to decrease avoidable hospitalizations includes the use of tools to identify changes in NH residents’ condition. The geriatric nursing assistant (GNA) is the frontline care provider for the NH resident and the GNA can identify subtle signs or behavior changes in the residents. The Stop and Watch Early Warning Tool (SWT) provides a method for the GNA to identify and communicate changes in the resident’s condition to the licensed provider to prompt early assessment and possible interventions to prevent hospital readmission. Purpose: To implement and evaluate the impact of using the SWT in a skilled care unit within a nursing home. Methods: All of the staff on a 37-bed skilled unit were educated on the use of the SWT and the SWT was implemented on the skilled unit. Results: Three hundred thirty-six SWTs were completed for a total of 15 days. Six weeks prior to implementing the SWT, the unit's readmission rate was 25%. Post-implementation, the unit's readmission rate was 18%. Conclusion: Although there was a decrease in the readmission rate post-implementation of the SWT, these data will need to be trended over several months to determine if there is a significant change in readmission rates to the hospital. The SWT tool was positively received by the staff; however, a barrier to use of the SWT included a high documentation burden for the GNAs. Future use of the SWT should target high-risk patients.