Date of Award

Spring 3-29-2018

Degree Type


Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Dr. Kimberly Hires

Second Advisor

Dr. Candace Kemp

Third Advisor

Dr. Jae Pak



Title: Interdisciplinary documentation and communication needs assessment for

emergency department transfers in assisted living facilities

Purpose: The purpose of this quality improvement project was to examine communication and documentation practices among interdisciplinary providers of residents in assisted living facilities (ALFs) who experience acute health changes that lead to emergency department (ED) transfers. The specific aim of this project was to map patterns of communication and documentation of acute health changes in residents of ALFs by interdisciplinary providers that result in ED visits to identify gaps in provider knowledge, practice and predictor variables.

Method: Retrospective chart reviews of three ALFs in the state of Georgia was conducted. Charts were randomly selected from facilities’ lists of ED transfers over the last 24 months. An analysis of current practice and standard practice was done to identify specific areas for improvement. Upon completing the interviews, improvement plans for addressing the gaps using INTERACT® will be developed for each facility.

Results: A total of 61 charts were reviewed. Three main areas were identified: 1) incomplete documentation of acute health changes, 2) incomplete documentation of disposition following acute health changes, and 3) incomplete documentation of provider notification. All three facilities used an incident report form or electronic form which included nature of the acute health change, communication to provider and disposition of the resident. There was a significant deficiency in documentation and communication of acute health changes which led to ED transfers.

Conclusion: Direct care providers’ deficiencies in documentation and communication regarding acute health changes of residents in ALFs may be a factor leading to avoidable ED transfers. There are implications for a quality improvement program to address the documentation and communication gaps in ALFs regarding residents’ acute health changes which leads to avoidable ED transfers.