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

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

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

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