Title: Improving the transfer process from the skilled nursing facility (SNF) to the emergency department (ED): Adding a communication hand-off toolByMelissa V. Williams (Under the direction of faculty chair Dr. Kathleen Jordan)Program: Doctor of Nursing Practice Abstract Purpose: The purpose of the DNP project was to pilot and implement a written communication hand-off tool that was designed to facilitate improved written interaction between the Brian Center SNF and the Carolinas Medical Center (CMC) main Emergency Department.Background: Evidence is available in emergency medicine that addresses the fragmented, bidirectional flow of information during the transitional phases of residents presenting from SNFs for acute concerns. Methods: A one-page communication hand-off tool was created using the results from a Likert scale questionnaire. Pre-testing, education intervention, and post-testing was given to 14 SNF nurses. Instructions for data collection confirmed by 54 ED nurses at CMC Main. Results: A paired t test was applied to the pre and post test scores using SPSS. The average score on the pretest was 73% compared to the mean average score of 97% on the posttest. The p-value was 0.000, indicating a true significance of the education between testing. 100% of the SNF nurses polled answered "yes" to being satisfied with the hand-off tool on the post satisfaction survey. Conclusion: The transfer process from the SNF to the ED has been a mutual task among long-term care facilities. However, hand-off tools that are concise, thorough, but easily assessible and simple to complete increase nurse satisfaction and minimize patient risks. Key Words: Communication, Skilled Nursing Facilites, Emergency Department, Transfer, Hand-off tools