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American Geriatrics Society. Improving the Quality of Transitional Care for Persons with Complex Care Needs. American Geriatrics Society (AGS) Position Statement. Journal of the American Geriatrics Society. 2007;51(4): 556-557. http://www.caretransitions.org/documents/Improving%20the%20quality%20-%20JAGS. Pdf. Published March 2007. Accessed August 7, 2014. The assisted living (AL) setting is subject to multiple transitional care points. Each transition is an opportunity for a collaborative, multidisciplinary process. Of course, this can only occur with careful planning at both ends of the transition. For this process to be successful, a coordinated system involving several members of the multidisciplinary team is required. One important component of ensuring a successful process is open, regular communication with all the critical channels. By having a point person in the AL facility serve as the liaison and educator between each channel, a successful transitional care process can be achieved.
August 7, 2019
Identifying Post-Acute Medication Discrepancies in Community Dwelling Older Adults: A New Tool.
Smith JD, Coleman EA, Min S-J.Am J Geriatr Pharmacother. 2004;2(2):141-148. http://www.caretransitions.org/documents/Identifying%20post%20acute%20-%20AJGP%20Abstract.pdf . Accessed August 7, 2014. Results: Across all 3 clinical disciplines, the mean interrater reliability (κ) for the 20 vignettes was 0.56 (15% low agreement, 80% good agreement, and 5% excellent agreement). Within disciplines, the κ statistic was as […]
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Smith JD, Coleman EA, Min S-J.Am J Geriatr Pharmacother. 2004;2(2):141-148. http://www.caretransitions.org/documents/Identifying%20post%20acute%20-%20AJGP%20Abstract.pdf . Accessed August 7, 2014. Results: Across all 3 clinical disciplines, the mean interrater reliability (κ) for the 20 vignettes was 0.56 (15% low agreement, 80% good agreement, and 5% excellent agreement). Within disciplines, the κ statistic was as follows: nurses, 0.68; pharmacists, 0.50; and physicians, 0.64. Intrarater reliability ranged from 0.58 to 0.69. Conclusions: By capturing transition-related medication discrepancies, the MDT fills an important gap in national efforts to promote patient safety. MDT items are actionable at both the patient and system level, suggesting that this tool could be used to foster continuous quality improvement efforts.
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August 7, 2019
AHRQ. Patient Safety Network. PSNet.
Agency for Healthcare Research and Quality. Patient Safety Network. PSNet. [Web site]. http://psnet.ahrq.gov/default.aspx . Updated July 30, 2014. Accessed July 30, 2014. This toolkit includes comprehensive information for patients and families to facilitate safe transitions from hospital to follow-up care.
Agency for Healthcare Research and Quality. Patient Safety Network. PSNet. [Web site]. http://psnet.ahrq.gov/default.aspx . Updated July 30, 2014. Accessed July 30, 2014. This toolkit includes comprehensive information for patients and families to facilitate safe transitions from hospital to follow-up care.
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August 7, 2019
Tying up loose ends: Discharging patients with unresolved medical issues. Archives of Internal Medicine 167, pp. 1305-1311.
Background: Patients are increasingly being discharged from the hospital with unresolved medical problems requiring outpatient follow-up. This study evaluates the frequency with which hospital physicians recommend outpatient workups to address patients’ unresolved medical problems and the impact that availability of discharge summaries has on workup completion. Methods: We conducted a […]
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Background: Patients are increasingly being discharged from the hospital with unresolved medical problems requiring outpatient follow-up. This study evaluates the frequency with which hospital physicians recommend outpatient workups to address patients' unresolved medical problems and the impact that availability of discharge summaries has on workup completion. Methods: We conducted a retrospective cohort study of patients discharged from the medicine or geriatrics service of a large teaching hospital between June 1, 2002, and December 31, 2003. Each subject's inpatient medical record was reviewed to determine if the hospital physician recommended an outpatient workup. Subjects' outpatient medical records were then reviewed to determine if the workups were completed. Results: Of 693 hospital discharges, 191 discharged patients (27.6%) had 240 outpatient workups recommended by their hospital physicians. The types of workups were diagnostic procedures (47.9%), subspecialty referrals (35.4%), and laboratory tests (16.7%). The most common diagnostic procedures were computed tomographic scans to follow up abnormalities seen on previous radiographic studies and endoscopic procedures to follow up gastrointestinal tract bleeding. Of recommended workups, 35.9% were not completed. Increasing time to the initial postdischarge primary care physician visit decreased the likelihood that a recommended workup was completed (odds ratio, 0.77; P = .002), and availability of a discharge summary documenting the recommended workup increased the likelihood of workup completion (odds ratio, 2.35; P = .007). Conclusions: Noncompletion of recommended outpatient workups after hospital discharge is common. Primary care physicians' access to discharge summaries documenting the recommended workup is associated with better completion of recommendations. Future research should focus on interventions to improve the quality and dissemination of discharge information to primary care physicians.
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August 7, 2019
Questions Are the Answer
Asking questions and providing information to your doctor and other care providers can improve your care. Talking with your doctor builds trust and leads to better results, quality, safety, and satisfaction. Quality health care is a team effort. You play an important role. One of the best ways to communicate […]
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Asking questions and providing information to your doctor and other care providers can improve your care. Talking with your doctor builds trust and leads to better results, quality, safety, and satisfaction. Quality health care is a team effort. You play an important role. One of the best ways to communicate with your doctor and health care team is by asking questions. Because time is limited during medical appointments, you will feel less rushed if you prepare your questions before your appointment.
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August 7, 2019
The hospital discharge: A review of a high risk care transition with highlights of a reengineered discharge process. Journal of Patient Safety 3(2), pp. 97-106.
The hospital discharge is a handoff, ripe embedded structural risks and hazards that can result in passive or active failures among “sharp end” providers. These failures can result in medical errors and an array of postdischarge adverse events. There are now emerging data to suggest that postdischarge-related adverse events and […]
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The hospital discharge is a handoff, ripe embedded structural risks and hazards that can result in passive or active failures among "sharp end" providers. These failures can result in medical errors and an array of postdischarge adverse events. There are now emerging data to suggest that postdischarge-related adverse events and rehospitalizations can be reduced through interventions at the time of hospital discharge. This article reviews the modifiable components of the hospital discharge process related to adverse events and rehospitalizations, including those relating to the characteristics of the hospital, patient, and clinician. Using multimethod analysis, our group described the principles thought to be important to the discharge process and delineated what we now call the reengineered discharge, a set of 11 discrete and mutually reinforcing components that we believe should be consistently part of every hospital discharge. Finally, we discuss the work or the National Quality Forum Consensus Standards Maintenance committee who, in 2006, added the hospital discharge as one of its "safe practices for better healthcare."
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