Lost Transitions

Dear Dr. Jeff: The major referral hospital for our skilled nursing facility is a highly rated academic medical center. Nevertheless, they repeatedly transfer to us medically complex patients who may be unstable, typically with minimal, inaccurate, or incomplete information. Sometimes they also have suggested care regimens that are inappropriate or unfeasible for a post-acute setting, from sources who are clearly not the attending physician. These transfers usually occur during the evening hours when only nursing staff are still present in the facility, placing a giant burden on evening staff to obtain needed orders to initiate care and unable to find anyone at the hospital to provide additional information.