The current process of transitioning to a skilled nursing facility (SNF) is non-transparent and inefficient. For patients and caregivers, the process is stressful and confusing. For the providers and the hospital, it could result in lower patient satisfaction and increase patient length of stay. For SNF administrators, it often causes a mismatch of patient expectations. To improve this process, we developed and piloted a patient-facing web application called Rockfish that utilizes a user-friendly interface that assists patients in selecting the most suitable SNF. 


This pilot has three specific aims: (1) to determine applicability of Rockfish in the inpatient setting, (2) to study the changes to the level of patient overall understanding of SNFs, and (3) to assess the impact to patient satisfaction during the hospital stay. 


The pilot ran from June 2014 to September 2014 at Stanford Hospital in California. The study population was the general medicine ward patients that were SNF eligible according to Medicare guidelines. If a patient did not speak English or was cognitively impaired, a caregiver served as the patient’s surrogate. Half of the patients were randomly assigned to the control group where they received the standard process while the other half were randomly assigned to the treatment group where Rockfish was used. The Rockfish application was either accessed by a web-enabled device that the patient owned or a hospital provided Apple iPad 2. For the study, research assistants administered a pre-survey and a post-survey to all of the patients and provided an overview of the Rockfish application features. During the four-month pilot, we enrolled 37 patients (22 in treatment and 15 in control) – patients were closely matched by age and gender between the treatment and the control, averaging 71 y/o and 45% male in the treatment group vs. 76 y/o and 40% male in the control group.

Results for aim 1 show 57% of the treatment group were able to select a SNF in less than 30 minutes by using the Rockfish application. Also, 91% of all respondents owned one or more web-enabled device with the smartphone being the most popular at 68%. For aim 2, we used patient understanding of SNF cost as a marker for SNF overall understanding. We compared the % change before and after the patients selected a SNF. We saw a positive 109% change in level of understanding in the treatment group compared to 15% change in the control group. For aim 3, 78% of the treatment group reported a 4 or 5 on a Likert scale when asked about their hospital experience with 5 being highest satisfaction compared to 61% in the control group. Furthermore, 84% of users reported a 4 or 5 on their experience using the Rockfish application with 5 being the highest satisfaction score. At the end of the pilot, focus sessions with five case managers revealed the following themes: Rockfish did not disrupt current work flow; Rockfish decreased the number of questions from patients; Rockfish is a good source of information for providers and patients alike. Next steps include providing Rockfish to more inpatients and expanding to the outpatient setting.


With a steady increase in the elderly population as well as utilization of post-acute care facilities, this is an opportunity to create a more transparent transitional care. This easily implemented and user-friendly solution can engage the patients and their caregivers to participate in the discharge process which translates into higher quality care and satisfaction.