Publication Date


Document Type

Scholarly Project




The purpose of this quality improvement project initiated by a core project team in a large medical center was to investigate possible causes for increased hospital readmissions from one specific skilled nursing facility. The conceptual framework utilized was the Define, Measure, Analyze, Improve, Control (DMAIC) model from the Lean Six Sigma methodology. Data collection from chart audits, a staff survey, a system probe, and a process mapping project assisted to narrow the focus of the plan to improve communication among facilities by standardizing documentation and coordination of care as patients transitioned from the skilled nursing facility to the medical center’s emergency department. Thirty-day post-implementation process measurements revealed essentially no change in uniformity of medical records accompanying patients to the emergency department. The hospital readmission rate from the one specific nursing facility increased from the preceding two months. Although ineffective communication and a variability of documentation accompanying patients to the emergency department may be contributing factors to the increased rehospitalization rates, it is unsupported by the outcome measure of this project due to an increased readmission rate thirty days post-implementation of interventions aimed at standardizing documentation and improving communication.

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Nursing Commons