Study: RAFT Model Reduces ED Transfers, Hospital Utilization

August 13, 2019

A transfer to the Emergency Department (ED) can be lifesaving for frail elders, but it also poses a risk for increased suffering and debility. In addition, studies have shown that many ED transfers from skilled nursing facilities (SNFs) are both unwarranted and avoidable. Now a new study in the August issue of JAMDA shows how the Reducing Avoidable Facility Transfers (RAFT) model reduces ED transfers and some acute health care utilization among SNF residents.

In Reducing Avoidable Facility Transfers: Outcomes of a Team Model to Minimize Unwarranted Emergency Care at Skilled Nursing Facilities, the authors described the use of the RAFT model in three SNFs between January 1, 2016, and June 30, 2017, to reduce unnecessary, avoidable acute care utilization among residents. RAFT consists of several components, including a small team of providers who manage longitudinal care and after-hours calls; a systematic elicitation of advance care plans, including acute-care preferences; increased engagement of the provider during an acute-care event; and biweekly meetings to discuss/review each case.

While results varied across categories, all three SNFs in the study demonstrated substantial reductions in ED transfers and hospitalizations. Mean monthly ED transfers decreased by 35.8%. Mean monthly hospitalizations decreased by 30.5%. Although the authors did not have access to claims data, they were able to document reductions in monthly post-acute and long-term care charges.

The authors concluded, “Like other models, RAFT provides evidence that much of the acute care provided to SNF residents can be provided more safely, more effectively, and more inexpensively than is currently the norm.” They further noted that while their study was small, the magnitude of its results is at least equal to those of larger studies.

This study was conducted by researchers at Dartmouth Hitchcock Medical Center (General Internal Medicine), Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH; The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH; The Collaboratory for Implementation Science at Dartmouth, Lebanon, NH; Dartmouth Centers for Health & Aging, Lebanon, NH; Population Health for D-H Health, Lebanon, NH; and The Mongan Institute—Massachusetts General Hospital, Boston, MA.

Click here for more information on the findings above and more details about the study. To contact the researchers or JAMDA editor for an interview, please email



JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.

About the Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.