August 7, 2019

NTOCC Care Transitions Informational Brochure

This brochure contains easy to understand information about transitions of care that can help you in sharing and discussing this critical health care issue.
This brochure contains easy to understand information about transitions of care that can help you in sharing and discussing this critical health care issue.
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http://www.ntocc.org/Portals/0/Informational_Brochure.pdf

August 7, 2019

Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists

The period following discharge from the hospital is a vulnerable time for patients. About half of adults experience a medical error after hospital discharge, and 19%-23% suffer an adverse event, most commonly an adverse drug event. This article reviews several important challenges to providing high-quality care as patients leave the […]
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The period following discharge from the hospital is a vulnerable time for patients. About half of adults experience a medical error after hospital discharge, and 19%-23% suffer an adverse event, most commonly an adverse drug event. This article reviews several important challenges to providing high-quality care as patients leave the hospital. These include the discontinuity between hospitalists and primary care physicians, changes to the medication regimen, new self-care responsibilities that may stress available resources, and complex discharge instructions. We also discuss approaches to promoting more effective transitions of care, including improvements in communication between inpatient and outpatient physicians, effective reconciliation of prescribed medication regimens, adequate education of patients about medication use, closer medical follow-up, engagement with social support systems, and greater clarity in physician-patient communication. By understanding the key challenges and adopting strategies to improve patient care in the transition from hospital to home, hospitalists could significantly reduce medical errors in the postdischarge period.
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http://onlinelibrary.wiley.com/doi/10.1002/jhm.228/abstract

August 7, 2019

Integrating best evidence into patient care: a process facilitated by a seamless integration with informatics tools

The Vanderbilt University paper discusses how the Eskind Biomedical Library at Vanderbilt University Medical Center transitioned from a simplistic approach that linked resources to the institutional electronic medical record system, StarPanel, to a value-added service that is designed to deliver highly relevant information. Clinical teams formulate complex patient-specific questions via […]
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The Vanderbilt University paper discusses how the Eskind Biomedical Library at Vanderbilt University Medical Center transitioned from a simplistic approach that linked resources to the institutional electronic medical record system, StarPanel, to a value-added service that is designed to deliver highly relevant information. Clinical teams formulate complex patient-specific questions via an evidence-based medicine literature request basket linked to individual patient records. The paper transitions into discussing how the StarPanel approach acted as a springboard for two additional projects that use highly trained knowledge management librarians with informatics expertise to integrate evidence into both order sets and a patient portal, MyHealth@Vanderbilt.
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http://connection.ebscohost.com/c/articles/52545915/integrating-best-evidence-patient-care-process-facilitated-by-seamless-integration-informatics-tools

August 7, 2019

CAPS: Care Transitions Glossary of Terms

A listing of words patient advisors suggested would be helpful for consumers to help them understand terms that may arise during the transition out of the hospital.
A listing of words patient advisors suggested would be helpful for consumers to help them understand terms that may arise during the transition out of the hospital.
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http://www.patientsafety.org/file_depot/0-10000000/20000-30000/24986/folder/85204/glossary.pdf

August 7, 2019

Patterns of emergency care use in residential care settings: opportunities to improve quality of transitional care in the elderly

Emergent care is a prominent feature in the complex matrix of care transitions for vulnerable elders. This article evaluates local patterns of emergent care transport using ambulance transport data for the year 2003, analyzed by residential setting (independent senior apartments, licensed residential care and nursing homes). Significant differences were found […]
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Emergent care is a prominent feature in the complex matrix of care transitions for vulnerable elders. This article evaluates local patterns of emergent care transport using ambulance transport data for the year 2003, analyzed by residential setting (independent senior apartments, licensed residential care and nursing homes). Significant differences were found between categories and between facilities within categories (p < .001). The more than three-fold difference in ambulance transport rate between nursing homes reinforces the need to recognize these transitions as quality indicators. Differences between senior apartments and licensed residential care settings provide initial insight suggesting opportunities for quality improvement in these community settings.
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http://www.tandfonline.com/doi/abs/10.1300/J027v26n04_06

August 7, 2019

The central role of performance measurement in improving the quality of transitional care

The objectives of this study were: (1) to demonstrate the ability of the Care Transitions Measure (CTM) to identify care deficiencies; (2) to devise and implement a quality improvement approach designed to remedy these deficiencies; (3) to assess the impact of the quality improvement approach on CTM scores; and (4) […]
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The objectives of this study were: (1) to demonstrate the ability of the Care Transitions Measure (CTM) to identify care deficiencies; (2) to devise and implement a quality improvement approach designed to remedy these deficiencies; (3) to assess the impact of the quality improvement approach on CTM scores; and (4) to test whether the CTM-3 predicts return to the emergency department. The CTM was found to be a sensitive tool able to capture changes in performance. The 3-item CTM was found to significantly predict post-hospital return to the emergency department within the first 30 days (p = 0.004).
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http://www.tandfonline.com/doi/abs/10.1300/J027v26n04_07

August 7, 2019

A research and policy agenda for transitions from nursing homes to home

More than 1 million adults make the transition from nursing homes to the community every year, often using formal health services including Medicare Part A skilled home health care. Although the need for discharge planning is well described, and the risks associated with care transitions are increasingly recognized, there is […]
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More than 1 million adults make the transition from nursing homes to the community every year, often using formal health services including Medicare Part A skilled home health care. Although the need for discharge planning is well described, and the risks associated with care transitions are increasingly recognized, there is very limited information about the process and outcomes as patients move from nursing home to home. This paper reviews pertinent published data and health services research as background information and outlines a research agenda for studying these important transitions.
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http://www.tandfonline.com/doi/abs/10.1300/J027v26n04_09

August 7, 2019

MI system leads in effort to improve transitions

In discharging patients, use a risk assessment tool to identify at-risk patients. Create interventions based on findings from screening tool: Multidisciplinary collaboration is key to positive discharges.
In discharging patients, use a risk assessment tool to identify at-risk patients. Create interventions based on findings from screening tool: Multidisciplinary collaboration is key to positive discharges.
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http://www.rightathome.net/foxvalley/blog/mi-system-leads-in-effort-to-improve-transitions/

August 7, 2019

CAPS: Communicating With Patients and Families for Smooth, Safe Transitions

This short document explains how patients and families often feel during this stressful time, and how healthcare providers can open lines of communication. It can be used by hospital training personnel to lay a foundation for understanding if the toolkit is rolled out organization wide.
This short document explains how patients and families often feel during this stressful time, and how healthcare providers can open lines of communication. It can be used by hospital training personnel to lay a foundation for understanding if the toolkit is rolled out organization wide.
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http://patientsafety.org/file_depot/0-10000000/20000-30000/24986/folder/85204/Communicating.pdf

August 7, 2019

CAPS Poster: The Emotional Side of Healthcare: Six Tips for Talking to Your Healthcare Team

A condensed poster version of the brochure that lists the six tips for communicating with your healthcare team.
A condensed poster version of the brochure that lists the six tips for communicating with your healthcare team.
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http://www.patientsafety.org/file_depot/0-10000000/20000-30000/24986/folder/85204/Team_Poster_White.pdf

August 7, 2019

On the case: effective care transitions

In this new era of patient safety, the case manager, as an advocate and facilitator of care, has a pivotal role on the front line of healthcare delivery.
In this new era of patient safety, the case manager, as an advocate and facilitator of care, has a pivotal role on the front line of healthcare delivery.
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http://journals.lww.com/nursingmanagement/Abstract/2008/01000/On_the_case__Effective_care_transitions.7.aspx

August 7, 2019

On the same page: making transitions between EMS & urgent care centers smooth

Medic 25 is called to a local urgent care center to a chief complaint of a possible heart attack at 8:45 p.m. On their way there, one of the medics tells his partner they’ve been getting multiple calls to this facility at about the same time each evening, so they […]
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Medic 25 is called to a local urgent care center to a chief complaint of a possible heart attack at 8:45 p.m. On their way there, one of the medics tells his partner they've been getting multiple calls to this facility at about the same time each evening, so they can "unload" their patients before it closes at 9 p.m. He says it's usually for minor complaints and seems to be more for the convenience of the urgent care center staff than for any true emergencies.
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http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20708144

August 7, 2019

Efficacy of a geriatrics team intervention for residents in dementia-specific assisted living facilities: effect on unanticipated transitions

OBJECTIVES To determine whether a multidisciplinary team intervention minimizes unanticipated transitions from assisted living for persons with dementia. DESIGN Randomized trial. SETTING Two dementia-specific assisted living facilities in Connecticut owned and managed by the same corporation. PARTICIPANTS One hundred older adults with dementia who relocated to assisted living. INTERVENTION Four […]
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OBJECTIVES To determine whether a multidisciplinary team intervention minimizes unanticipated transitions from assisted living for persons with dementia. DESIGN Randomized trial. SETTING Two dementia-specific assisted living facilities in Connecticut owned and managed by the same corporation. PARTICIPANTS One hundred older adults with dementia who relocated to assisted living. INTERVENTION Four systematic multidisciplinary assessments by a geriatrician, geriatrics advanced practice nurse, physical therapist, dietitian, and social worker during the first 9 months of relocation to assisted living. MEASUREMENTS Permanent relocation to a nursing facility, emergency department (ED) visits, hospitalization, and death. RESULTS Fifty-five residents experienced any unanticipated transition out of assisted living, on average 84 +/- 74 days after relocation; falls were the primary reason for transition. The intervention reduced the risk of any unanticipated transitions (13%), permanent relocation to a nursing facility (11%), ED visits (12%), hospitalization (45%), and death (63%), but the results did not meet statistical significance. In secondary analysis, more men experienced any unanticipated transition (P<.001), hospitalization (P<.001), or death (P<.001) than women. CONCLUSION Although an untargeted multidisciplinary intervention did not significantly reduce the risk of transitions for individuals with dementia relocating to assisted living in this small sample, trends for decreasing hospitalization and death were found. The data further suggest that those at risk for falls and men may benefit from targeted clinical interventions to prevent unanticipated transitions, especially during the first 3 months after relocation.
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http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2007.01591.x/abstract

August 7, 2019

CAPS Poster: The Emotional Side of Healthcare: Six Tips for Talking to Your Doctor

A condensed poster version of the brochure that lists the six tips for communicating with your doctor.
A condensed poster version of the brochure that lists the six tips for communicating with your doctor.
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http://www.patientsafety.org/file_depot/0-10000000/20000-30000/24986/folder/85204/Doctor_Poster_White.pdf

August 7, 2019

Hospital readmissions under the spotlight

Healthcare leaders see the future of their dynamic industry through the eyes of patients, families, providers, clinicians, employers, health insurers, and policymakers. As healthcare organizations face growing economic challenges and the nation engages in comprehensive healthcare reform, reducing preventable readmissions is considered part of the solution to achieving new system-wide […]
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Healthcare leaders see the future of their dynamic industry through the eyes of patients, families, providers, clinicians, employers, health insurers, and policymakers. As healthcare organizations face growing economic challenges and the nation engages in comprehensive healthcare reform, reducing preventable readmissions is considered part of the solution to achieving new system-wide efficiencies. Healthcare leaders can adopt a fresh approach to reducing preventable readmissions that includes three basic components: (1) identify patients at risk for readmission based on sociodemographic factors, care-related factors, and measures of severity of illness; (2) anticipate reform that aligns reimbursements and payment incentives for readmission reductions; and (3) structure coordinated, patient-centered discharge planning. Three innovative programs can be used to coordinate care at discharge: the Society of Hospital Medicine's Better Outcomes for Older Adults Through Safe Transitions project; Boston University Medical Center's Reengineered Hospital Discharge project; and the Institute for Healthcare Improvement's STate Action on Avoidable Rehospitalizations initiative. This three-pronged approach will help organizations proactively create mechanisms that are aligned with the national agenda and that keep people healthy at home after hospital discharge.
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https://www.ncbi.nlm.nih.gov/pubmed/20812526?dopt=Citation

August 7, 2019

A theoretical framework and competency-based approach to improving handoffs

BACKGROUND Once characterised by remarkable continuity of care by a familiar doctor, patient care today is delivered by multiple physicians with varying degrees of knowledge of the patient. Yet, few trainees learn the potential risks of these transitions and the strategies to improve patient care during handoffs. Little is known […]
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BACKGROUND Once characterised by remarkable continuity of care by a familiar doctor, patient care today is delivered by multiple physicians with varying degrees of knowledge of the patient. Yet, few trainees learn the potential risks of these transitions and the strategies to improve patient care during handoffs. Little is known regarding the mechanisms by which handoffs affect patient care. RESULTS Building on theoretical constructs from the social sciences and illustrated with a case study of the implementation of a night float service for the inpatient general medicine services at the University of Chicago, a conceptual framework is proposed to describe how handoffs affect both patients and physicians. CONCLUSION Using this conceptual framework, recommendations are made for formal education based on the core competencies of communication and professionalism. Opportunities to educate trainees in acquiring these skills are described in the context of handoffs of patient care.
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http://qualitysafety.bmj.com/content/17/1/11.full?sid=eb79ca0a-ea29-4a55-a7b9-fe67c68b1be5

August 7, 2019

Improving patient safety culture

PURPOSE Improving hospital patient safety means an open and stimulating culture is needed. This article aims to describe a patient safety culture improvement approach in five Belgian hospitals. DESIGN/METHODOLOGY/APPROACH Patient safety culture was measured using a validated Belgian adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire. Studies […]
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PURPOSE Improving hospital patient safety means an open and stimulating culture is needed. This article aims to describe a patient safety culture improvement approach in five Belgian hospitals. DESIGN/METHODOLOGY/APPROACH Patient safety culture was measured using a validated Belgian adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire. Studies before (autumn 2005) and after (spring 2007) the improvement approach was implemented were completed. Using HSOPSC, safety culture was measured using 12 dimensions. Results are presented as evolving dimension scores. FINDINGS Overall, 3,940 and 3,626 individuals responded respectively to the first and second surveys (overall response rate was 77 and 68 percent respectively). After an 18 to 26 month period, significant improvement was observed for the "hospital management support for patient safety" dimension--all main effects were found to be significant. Regression analysis suggests there is a significant difference between professional subgroups. In one hospital the "supervisor expectations and actions promoting safety" improved. The dimension "teamwork within hospital units" received the highest scores in both surveys. There was no improvement and sometimes declining scores in the lowest scoring dimensions: "hospital transfers and transitions", "non-punitive response to error", and "staffing". RESEARCH LIMITATIONS/IMPLICATIONS The five participating hospitals were not randomly selected and therefore no representative conclusions can be made for the Belgian hospital sector as a whole. Only a quantitative approach to measuring safety culture was used. Qualitative approaches, focussing on specific safety cultures in specific parts of the participating hospitals, were not used. PRACTICAL IMPLICATIONS Although much needs to be done on the road towards better hospital patient safety, the study presents lessons from various perspectives. It illustrates that hospital staff are highly motivated to participate in measuring patient safety culture. Safety domains that urgently need improvement in these hospitals are identified: hospital transfers and transitions; non-punitive response to error; and staffing. It confirms that realising progress in patient safety culture, demonstrating at the same time that it is possible to improve management support, is complex. ORIGINALITY/VALUE Safety is an important service quality aspect. By measuring safety culture in hospitals, with
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http://www.emeraldinsight.com/journals.htm?articleid=1865014

August 7, 2019

CAPS Brochure: The Emotional Side of Healthcare: Six Tips for Talking to Your Doctor

A tri-fold brochure presenting six strategies for coping with conversations that often feel stressful for patients and families. This can also serve as a reminder or educational tool for healthcare team members to raise their sensitivity to the emotional realities patients bring with them as they talk to their doctor […]
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A tri-fold brochure presenting six strategies for coping with conversations that often feel stressful for patients and families. This can also serve as a reminder or educational tool for healthcare team members to raise their sensitivity to the emotional realities patients bring with them as they talk to their doctor or nurse.
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http://www.patientsafety.org/file_depot/0-10000000/20000-30000/24986/folder/85204/Emotional_brochure.pdf

August 7, 2019

Care transitions for hospitalized patients

Ensuring safe care transitions is a core part of hospital medicine. These transitions include inpatient-outpatient transitions and in-hospital transitions. To ensure safe care during these transitions, clinicians should be aware of the types of transitions and the way in which these transitions can impede safe patient care. With this knowledge, […]
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Ensuring safe care transitions is a core part of hospital medicine. These transitions include inpatient-outpatient transitions and in-hospital transitions. To ensure safe care during these transitions, clinicians should be aware of the types of transitions and the way in which these transitions can impede safe patient care. With this knowledge, strategies to ensure patient safety during care transitions can be adopted and training directed at teaching physicians safe hands-off practices could be developed and supported.
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http://www.sciencedirect.com/science/article/pii/S002571250700171X

August 7, 2019

Improving transitions of care at hospital discharge–implications for pediatric hospitalists and primary care providers

Delays, omissions, and inaccuracy of discharge information are common at hospital discharge and put patients at risk for adverse outcomes. We assembled an interdisciplinary team of stakeholders to evaluate our current discharge process between hospitalists and primary care providers (PCPs). We used a fishbone diagram to identify potential causes of […]
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Delays, omissions, and inaccuracy of discharge information are common at hospital discharge and put patients at risk for adverse outcomes. We assembled an interdisciplinary team of stakeholders to evaluate our current discharge process between hospitalists and primary care providers (PCPs). We used a fishbone diagram to identify potential causes of suboptimal discharge communication to PCPs. Opportunities for improvement (leverage points) to achieve optimal transfer of discharge information were identified using tally sheets and Pareto charts. Quality improvement strategies consisted of training and implementation of a new discharge process including: (1) enhanced PCP identification at discharge, (2) use of an electronic discharge order and instruction system, and (3) autofaxing discharge information to PCPs. The new discharge process's impact was evaluated on 2,530 hospitalist patient discharges over a 34-week period by measuring: (1) successful transfer of discharge information (proportion of discharge information sheets successfully faxed to PCPs), (2) timeliness (proportion of sheets faxed within 2 days of discharge), and (3) content (presence of key clinical elements in discharge sheets). Postintervention, success, and timeliness of discharge information transfer between pediatric hospitalists and PCPs significantly improved while content remained high.
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http://scienceindex.com/stories/1058641/Improving_Transitions_of_Care_at_Hospital_DischargeImplications_for_Pediatric_Hospitalists_and_Primary_Care_Providers.html