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INTERACT II: Education and Clinical Tools for Reducing Transfers from Nursing Homes to Hospitals


INTERACT II (Interventions to Reduce Acute Care Transfers) is a series of educational and clinical tools, developed with Commonwealth Fund support, designed to reduce the number of avoidable transfers from nursing homes to hospitals. The goal is to improve the early identification and evaluation of changes in residents' status that could lead to hospitalizations, as well as to improve communication about these changes.

The Issue

Transfers to the hospital from a long-term care setting are costly and put residents at risk by causing emotional and physical stress and potential complications such as hospital-acquired infections.

Target Audience

Nursing home staff, including certified nursing assistants (CNAs), nurses, physicians, physician assistants, and social workers.

The Intervention

INTERACT II is a series of educational and clinical tools designed to reduce the number of avoidable transfers from nursing homes to hospitals. They were developed by a team led by Joseph G. Ouslander, M.D., a professor and associate dean for Geriatric Programs at the Charles E. Schmidt College of Medicine at Florida Atlantic University, with input from a variety of direct care providers and national experts. The tools aim to help nursing home staff safely manage residents' acute conditions rather than reflexively transfer them to the hospital.

The INTERACT II tools were refined and tested in a six-month collaborative improvement project with 25 nursing homes in three states (Florida, New York, and Massachusetts). Nursing homes received the tools as well as on-site education and took part in regular teleconferences with an experienced nurse practitioner.

The INTERACT II tools cover:

Communication. These tools ensure vital information isn't lost due to shift changes, acute care transfers, or between doctors and nursing staff. They include a "Stop and Watch" card that lists changes such as "ate less than usual" and "participated in activities less than usual," which CNAs can circle and then discuss with the charge nurse before the end of their shift.

Advanced Care Planning. These tools are designed to assist with transitions to a palliative or comfort plan or hospice care. They include a guide for social workers and primary care physicians who work in nursing homes about initiating and carrying out conversations with residents and their families when there has been a decline in health status.

Quality Improvement. These forms help staff document details about resident transfers to an emergency department or for direct admission to the hospital.

Care Paths. These protocols guide the evaluation of specific symptoms that commonly cause acute care transfers, such as dehydration, fever, and lower respiratory infection.

For More Information

To learn more about INTERACT II, please visit the INTERACT II Web site at

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