Public Release: 

FAU develops guide on hospital transfers for nursing home residents and their families

'Go to the Hospital or Stay Here? A Decision Guide for Patients and Families' receives PCORI Award

Florida Atlantic University


IMAGE: FAU's Christine E. Lynn College of Nursing has received an Engagement Award from the Patient-Centered Outcomes Research Institute (PCORI) for a program to widely disseminate an evidence-based decision guide they've... view more

Credit: Florida Atlantic University

Hospitalization of nursing home residents are common and often result in complications and excessive costs. Nearly 1 in 4 people admitted to a skilled nursing facility from acute care are rehospitalized within 30 days at a cost of $14.3 billion annually. It is estimated that as many as two-thirds of those hospitalizations are avoidable. It's been suggested that the role of family members of nursing home residents heavily influences decisions related to transferring residents to the hospital. In order to make optimal decisions concerning hospitalizations, nursing home residents and their families need to have clear information about their treatment options and health conditions.

The Christine E. Lynn College of Nursing at Florida Atlantic University recently received a $50,000 Engagement Award from the Patient-Centered Outcomes Research Institute (PCORI) for a program to widely disseminate an evidence-based decision guide they've developed for nursing home residents and their families titled "Go to the Hospital or Stay Here? A Decision Guide for Patients and Families."

"Hospitalization carries many risks including falls, pressure ulcers, infections, decline in function, and disorientation," said Ruth Tappen, Ed.D., Christine E. Lynn Eminent Scholar and a professor in FAU's College of Nursing. "One way that we can effectively inform patients and facilitate the decision-making process is by using tools that support the exchange of information between the health care provider and the patient."

In a parent study, Tappen and colleagues identified the need for more effective decision support tools to help avoid two of the three most frequent reasons given by nursing home staff for avoidable or potentially avoidable hospital transfers: the insistence by the resident or family member for the transfer, and a communication gap between nursing staff, primary care providers and families.

"Even when the resident has a palliative condition that can be treated in the nursing home, there are some instances where family members may still demand hospitalization," said Tappen. "They might just be uninformed about the actual prognosis of the resident or simply unaware of the treatment options available in the nursing home. This is why tools like the guide we have developed are crucial to enhance communication and information sharing between all parties involved in the decision-making process."

The information package developed at FAU includes the guide, a smaller tri-fold and an implementation kit that will be available in both paper and electronic forms. With the PCORI funding award, FAU's College of Nursing will complete the translation of the guide and other materials into the top five languages spoken in the United States including English and Spanish. FAU will work with the American Health Care Association and Leading Age as well as consumer and professional organizations to enhance the distribution of the guide. Using this outreach effort will enable Tappen and her colleagues to reach their target population, which includes the residents themselves who typically have little or no internet access.

"Our ultimate goal with this program is to put the information contained in our guide into the hands of as many nursing home residents and their families as possible and to both improve quality of care and avoid unnecessary hospitalizations and associated costs," said Tappen.


FAU's College of Nursing is internationally known for its commitment to nursing as a discipline focused on nurturing the wholeness of persons and the environment through Caring. The College advances Caring knowledge through education, practice, research and scholarship to transform care locally, nationally and globally. Currently, the College of Nursing offers bachelor's, master's, DNP and Ph.D. degree programs with approximately 1,600 nursing students enrolled in its programs. For more information, visit

Florida Atlantic University

Florida Atlantic University, established in 1961, officially opened its doors in 1964 as the fifth public university in Florida. Today, the University, with an annual economic impact of $6.3 billion, serves more than 30,000 undergraduate and graduate students at sites throughout its six-county service region in southeast Florida. FAU's world-class teaching and research faculty serves students through 10 colleges: the Dorothy F. Schmidt College of Arts and Letters, the College of Business, the College for Design and Social Inquiry, the College of Education, the College of Engineering and Computer Science, the Graduate College, the Harriet L. Wilkes Honors College, the Charles E. Schmidt College of Medicine, the Christine E. Lynn College of Nursing and the Charles E. Schmidt College of Science. FAU is ranked as a High Research Activity institution by the Carnegie Foundation for the Advancement of Teaching. The University is placing special focus on the rapid development of critical areas that form the basis of its strategic plan: Healthy aging, biotech, coastal and marine issues, neuroscience, regenerative medicine, informatics, lifespan and the environment. These areas provide opportunities for faculty and students to build upon FAU's existing strengths in research and scholarship. For more information, visit

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