Impact of skilled nursing facility discharge on inpatient oncology quality outcomes

BACKGROUND: Hospitalist comanagement of inpatient oncology patients can improve length of stay (LOS), discharge time, and readmission rates. Identifying additional clinical factors affecting LOS and readmissions will guide further oncology hospitalist practice improvement. METHODS: Hospitalizations on the Smilow Cancer Hospital medical oncology service with discharge to home under self-care (n = 622), home with services (n = 462), or skilled nursing facility (n = 152) from July 1, 2021, to July 31, 2022, were included. Outcomes included LOS, time of discharge, and 30-day readmission rate. Multivariable mixed linear (LOS, time of discharge) or Poisson (30-day readmission rates) models were adjusted for demographics, cancer type, severity of illness index, house staff team, and fiscal quarter and included a random intercept for patient. Analyses were 2-sided with a priori statistical significance of less than 0.05. RESULTS: Patients discharged to a skilled nursing facility had a longer LOS (mean = 8.25 days, 95% confidence interval [CI] = 7.13 to 9.55 days) compared with patients discharged to home under self-care (mean = 3.04 days, 95% CI = 2.76 to 3.36 days) or with services (mean = 4.48 days, 95% CI = 4.03 to 4.97 days; P < .0001). Thirty-day readmission rates for patients discharged to a skilled nursing facility (43.99%) were 10 percentage points higher than those discharged home either under self-care (32.86%) or with services (33.48%; P = .14). These differences persisted in patients regardless of severity of illness index. Of the 152 patients discharged to a skilled nursing facility, 31 (20.3%) were readmitted specifically back to the medical oncology service within 60 days with 16 (51.6%) cycling back to a skilled nursing facility, which resulted in 11 second readmissions. CONCLUSION: For oncology patients requiring discharge to a skilled nursing facility, mindful and upfront discharge planning may improve care quality and efficiency.