Background. The well-cited report from the Institute of Medicine stated that nearly 100,000 deaths in acute care are largely due to miscommunication. Residents in nursing homes are transported for acute care three times higher than those under the age of 65. Approximately 25 percent of these hospital transfers are avoidable. The influence of nurse-to-physician communication upon the decision to hospitalize nursing home residents is not well understood. Objective. The purpose of this study is to explore nurse-to-physician communication in the nursing home setting utilizing the Informatics Research Organizing Model (IROM) and Carrington’s Exploring Nurse-to-Nurse Communication Framework. Methods. The methodology use for this study was a qualitative descriptive (QD) design, with in-depth, one-on-one interviews of nurses and physicians with semi-structured open-ended interview questions. Communication between nurses and physicians regarding clinical events experienced by nursing home residents was digitally recorded and transcribed. Data was analyzed using natural language processing (NLP) methodology and conventional content analysis, as a means of intra-methods data triangulation. A purposive convenience sample of nurses and physicians who provide clinical care to nursing home residents at two sites was recruited. In addition to obtaining recorded communications between nurses and physicians pertaining to clinical events, these same study participants were interviewed to determine their perceptions regarding communication of the clinical events. Outcomes. Findings from this study will increase understanding of nurse-to-physician communication and its contribution to avoidable hospitalizations. Results will inform the development of an electronic interface that supports nurse-to-physician communication in the nursing home setting.

Heart failure (HF) is a serious, life limiting chronic illness and is the most common cause of <30-day hospital readmission, which is costly both in its profound negative impact on patient mortality and quality of life, and in economics. Limited access to care in rural communities increases the prevalence of hospitalizations for heart disease in rural areas. The aims of this project using data mined from Arizona Health Sciences Center Clinical Research Data Warehouse, are to define clinical events (fever, pain, changes in respiratory status, change in level of consciousness, changes in output, bleeding, and suicide ideation) for patients with heart failure, and determine what assessment values are for chronically ill patients and compare to "normal" assessment values for non-chronically ill patients. A literature review was completed to determine how to define clinical events for chronically ill patients with HF, and how decision making is used at home to manage chronic illness. Assessment value data was mined from the clinical research data warehouse and compared to “normal” assessment values, with identification of associations between clinical events and action taken in the hospital. The project results support that there are differences in "normal" assessment values for fever, pain, and change in respiratory status between chronically ill patients with HF, and non-chronically ill patients; there was insufficient data to define bleeding, change in output, or suicide ideation. Impacts to care include earlier recognition of worsening HF symptoms that could result in an earlier call or visit to primary care provider forestalling the need for emergent care and hospital readmission. Application of the mined clinical may inform development of evidenced-based algorithm to guide decision-making at home, and it may also provide the foundation for the development of a tool for patient use to prevent <30-day hospital readmission.