Hospital readmissions from skilled nursing facilities (SNFs) are a persistent and costly challenge, both for healthcare systems and for the well-being of patients. As CMS continues to penalize high readmission rates through value-based purchasing programs, SNFs must adopt more proactive, data-driven approaches to transitional care. Among the most promising innovations is the integration of next-day laboratory results that include antibiotic resistance gene testing. These results empower care teams to tailor treatments quickly and effectively, especially for patients at high risk of infection-related complications.
The Readmission Problem: A Brief Overview
Nearly one in four Medicare patients discharged to SNFs are readmitted to the hospital within 30 days. The causes range from uncontrolled infections and poor medication management to delayed recognition of clinical deterioration. Infections—particularly urinary tract infections (UTIs), pneumonia, and sepsis—are a leading driver of readmissions. Identifying and managing these infections early is key to keeping patients out of the hospital.
Why Next-Day Lab Results Matter
Traditional lab turnaround times often delay critical treatment decisions. Next-day lab results, especially those including molecular diagnostics and resistance gene testing, change the game. These results allow SNF clinicians to:
• Initiate or adjust antibiotic therapy with precision
• Avoid overuse of broad-spectrum antibiotics
• Monitor emerging patterns of resistance within the facility
• Reduce the risk of Clostridioides difficile (C. diff) and other complications
For example, a resident exhibiting signs of a UTI may be empirically treated with a common antibiotic like ciprofloxacin. If next-day lab results show resistance to fluoroquinolones but susceptibility to nitrofurantoin, the care team can pivot within 24 hours—often avoiding an ER visit or hospitalization.
Implementing the Protocol
Leading SNFs have begun integrating these lab capabilities into their clinical workflows:
1. Standing Orders & Rapid Specimen Collection: Facilities use standing orders to obtain urine, sputum, or wound cultures at the first sign of infection.
2. Partnering with Specialized Labs: SNFs contract with molecular diagnostic labs capable of delivering next-day results and resistance panels.
3. Nurse Practitioner-Led Review: NP teams review results daily and update treatment plans accordingly.
4. Documentation & Communication: All results and treatment changes are documented in the EHR and communicated to the full care team and the resident’s family.
Case Study: Avoiding a Sepsis Readmission
A 79-year-old male with COPD and a Foley catheter developed fever and confusion. The nursing team collected a urine sample and flagged the attending NP. Preliminary vitals were stable. Rather than transferring to the hospital, the team initiated conservative IV hydration and ordered a resistance gene panel. The next morning, results indicated ESBL-producing E. coli susceptible to fosfomycin. The patient was treated in-house with oral therapy, stabilized, and avoided hospitalization.
Conclusion
Reducing readmissions from SNFs requires more than vigilance—it demands smarter tools and faster data. Next-day lab results that include antibiotic resistance gene testing are proving to be a critical asset in infection management. As more SNFs adopt these protocols, they not only improve outcomes and reduce penalties, but also demonstrate a renewed commitment to high-quality, patient-centered care
