Date of Conferral



Doctor of Nursing Practice (DNP)




Alice Conway


The Effect of a Quality Improvement Initiative on Reducing Hospital Transfers of Nursing Home Residents


Denise Eileen Jarboe

MSN, Walden University, 2010

BS, University of Maryland, 1981

Project Study Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

February 2015

Nursing homes (NH) in the 21st century provide skilled healthcare services for resident populations who are older, frailer, and often suffering from multiple incurable chronic medical conditions. Nurses practicing in this setting must be keen observers and effective communicators with the ability to recognize and report subtle changes in health status that may lead to an avoidable or unnecessary hospital transfer. The purpose of this DNP project was to evaluate the impact of a quality assurance performance improvement (QAPI) initiative implementing the INTERACTTM (interventions to reduce acute care transfers) SBAR (situation, background, assessment/appearance, recommendation) communication tool in a skilled NH setting. The Synergy Model, which posits that optimal patient outcomes are possible when nurse competency is matched or synergized with patient care needs, provided the conceptual framework for this project. To evaluate the effect of the program, resident hospital transfer events groups before and after SBAR utilization (n = 295) were analyzed using a dependent t test to determine if significant differences existed in the groups in overall number of transfers, clinical condition categories, and those leading to an inpatient hospitalization. Although analysis of the data did not demonstrate significant decreases in resident transfer events, the results did provide valuable baseline information for future studies. This project contributed to social change by evaluating communication among care providers in a skilled NH setting, establishing baseline information and identifying the need for future projects. This information is vital for determining which resident transfers to the hospital are avoidable and for developing future programs addressing this practice issue.