All rights reserved. Evidence‐based interventions pre‐, post‐, and bridging discharge were categorized into 7 domains: (1) indication for hospitalization, (2) primary care, (3) medication safety, (4) follow‐up plans, (5) home‐care referral, (6) communication with outpatient providers, and (7) patient education (Table 1). It was also felt that daily interdisciplinary (ie, bullet) rounds would serve as the most appropriate venue to utilize the checklist tool. We have used a consensus process of stakeholders to develop a Checklist of Safe Discharge Practices for Hospital Patients that details the steps of events that need to be completed for every day of a typical hospitalization. Studies have found that improvements in hospital discharge planning can dramatically improve the outcome for patients as they move to the next level of care. Discharge planning is a complex activity, particularly in the context of new services offered outside hospital, like intermediate care, and having a population with more older people, who often have extremely complex care needs. essential elements of a safe, comprehensive, and quality discharge from the ED. ISSN 1553-5606, Toronto Central Community Care Access Centre, Toronto, Ontario, Canada, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada, Quality Healthcare Network, Toronto, Ontario, Canada, Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada, Department of Family and Community Medicine, University of Toronto, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada, Ontario Public Service, Toronto, Ontario, Canada, Division of General Internal Medicine, University of Toronto, Institute of Health Policy Management & Evaluation, University of Toronto, Institute for Clinical Evaluative Sciences, Department of Medicine, University of Toronto and Mount Sinai Hospital, Toronto, Canada, Checklist of Safe Discharge Practices for Hospital Patients, The incidence and severity of adverse events affecting patients after discharge from the hospital, Patient safety concerns arising from test results that return after hospital discharge, Deficits in communication and information transfer between hospital‐based and primary care physicians: implications for patient safety and continuity of care, “I wish I had seen this test result earlier!”: dissatisfaction with test result management systems in primary care, Lost in transition: challenges and opportunities for improving the quality of transitional care, Continuity of care and patient outcomes after hospital discharge, A reengineered hospital discharge program to decrease rehospitalization: a randomized trial, A Quality improvement intervention to facilitate the transition of older adults from three hospitals back to their homes, Reduction of 30‐day postdischarge hospital readmission or emergency department (ED) visit rates in high‐risk elderly medical patients through delivery of a targeted care bundle, Interventions to reduce 30‐day rehospitalization: a systematic review, Centers for Medicare and Medicaid Services. As with invasive procedures such as central venous catheterization, the first step of the discharge process is to obtain consent, which includes discussing its risks and benefits. Through its National Center on Caregiving, FCA offers information on current social, public policy and caregiving issues, provides assistance in the development of public and private programs for caregivers, and assists caregivers nationwide in locating resources in their communities. Do we need special instructions because my relative has Alzheimer, Eating (are there diet restrictions, e.g., soft foods only? c. Thoroughly explain discharge summary to patient (use teach‐back if needed). If that isnʼt enough, you will need to contact Medicare, Medicaid, or your insurance company. The goal of this exercise was to ensure that elements necessary for a successful discharge were viewed through the perspectives of interprofessional groups involved in the care of a patient. [23] For example, summaries containing structured sections such as relevant inpatient provider contacts, diagnoses, course in hospital, results of investigations (including pending results), discharge instructions and follow‐up, and medication reconciliation have been recommended to improve communication to outpatient providers. Think about both your needs as a caregiver and the needs of the person you are caring for, including language and cultural background. A standardized, evidence-based discharge process is critical to safe transitions for the hospitalized patient. The checklist domains include (1) indication for hospitalization, (2) primary care, (3) medication safety, (4) follow‐up plans, (5) home‐care referral, (6) communication with outpatient providers, and (7) patient education. The information below describes key elements of the IDEAL discharge from admission to discharge to home. [29, 30]Postdischarge care plays an important role in supporting the patient upon discharge and when part of a multifaceted discharge plan can result in decreased readmission rates and hospital utilization. Why is this medicine prescribed? [3] The expert panel agreed on admission notification, follow‐up appointment scheduling, and transfer of a high‐quality discharge summary to the patient's PCP, such as one described by Maslove and colleagues. This tool can aid efforts to optimize patient discharge from the hospital and improve outcomes.METHODSLiterature ReviewThe research team reviewed the literature to determine the nature and format of the core information to be contained in a discharge checklist for hospitalized patients. Is the facility clean, well kept, quiet, a comfortable temperature? Copyright © 2013 Society of Hospital Medicine. Some of the care your loved one needs might be quite complicated. Simplify and expand eligibility for public programs. Listed below are common care responsibilities you may be handling for your family member after he or she returns home: Community organizations can help with services such as transportation, meals, support groups, counseling, and possibly a break from your care responsibilities to allow you to rest and take care of yourself. (415) 434-3388 | (800) 445-8106 For example, patients admitted with heart failure can benefit from daily inpatient education around self‐monitoring, diet, and lifestyle counseling.[22]. More completely if the discharge is going to be an enduring one, the person will need to be able to function independently or with adequate support at home. Explain to patient how new medications relate to diagnosis. Author Information . On the other hand, research has shown that excellent planning and good follow-up can improve patientsʼ health, reduce readmissions, and decrease healthcare costs. [3] Use of validated scores such as the LACE index (a score calculated based on 4 factors: [L] length of hospital stay, [A] acuity on admission, [C] comorbidity, and [E] emergency department visits) to identify patients at high risk of readmission and targeting these individuals when arranging postdischarge follow‐up is encouraged. Studies have shown that numerous, and sometimes dangerous, errors can be made in home care when language is not taken into account at discharge. Finally, as the teach‐back method is an effective tool to ensure patient understanding of their health issues, the panel recommended its use when educating patients on medication use, plan of care, and discharge instructions. However, if something is determined by the doctor to be “medically necessary,” you may be able to get coverage for certain skilled care or equipment. Copyright © by Society of Hospital Medicine or related companies. Bibliographies of all relevant articles were reviewed to identify additional studies. The list of questions below will give you direction as you start your search for a facility. (a) Standard: Discharge planning process. For example, PCPs in group 1 were asked to consider an ideal discharge from the perspective of primary care. Often, transfer of important information and medication review take place only hours before a patient leaves the hospital, a suboptimal time for patient education. b. [28, 35] Just as standardized treatment protocols and care plans can improve outcomes,[36] a similar approach for discharge processes may facilitate safe transition from hospital to home. Start early and use appropriate escalation channels Convenience is a factor—you need to be able to easily get to the facility—but the quality of care is very important, and you may have to sacrifice your convenience for the sake of better care. Be aware that all unplanned, rushed or poorly coordinated discharges from hospitals are very dangerous! Contact PCP and notify of patient's admission, diagnosis, and predicted discharge date. Kripalani et al reviewed the literature for suggested methods of promoting effective transitions of care at discharge, and their results are consistent with those summarized in our discharge checklist. Daily teaching provides an opportunity to assess information carried over and accurate understanding of treatment plans, as well as to review changes in care plans that may be evolving during a hospitalization. c. If necessary, schedule postdischarge care. To help, a private geriatric care manager (for whom you will pay an hourly fee) or a social worker can offer much needed advice and support. Do I have transportation to get there? As a minimum the person needs to be able to ambulate independently if he is going to leave the department. Comprehensive information and advice to help family caregivers and healthcare providers plan transitions for patients. In addition, high‐risk patients may require an earlier follow‐up appointment with the PCP, and the panel supports attempts to arrange follow‐up within 7 days for at‐risk individuals. Discharge planning involves hospital staff thinking about when you will leave hospital, and what will happen You may have physical, financial, or other limitations that affect your caregiving capabilities. 04/28/2020 07:48:56. Very weak, legs have lost strength. This Fact Sheet will look at the keys to a successful transition from hospital to home, explain some important elements, offer suggestions for improving the process, and provide caregivers with checklists to help ensure the best care for a loved one. At the first meeting, the panel reviewed existing toolkits and evidence‐based recommendations around best discharge practices. The panel reached 100% agreement on the recommended timeline to implement elements of the discharge checklist. As caregiver, you are the “expert” in your loved oneʼs history. As a caregiver, you are focused completely on your family memberʼs medical treatment, and so is the hospital staff. Have I been given information either verbally or in writing that I understand and can refer to? E-mail: [email protected] What services will help me care for myself? Address for correspondence and reprint requests: Christine Soong, MD, Division of General Internal Medicine, Mount Sinai Hospital, 600 University Ave, Room 428, Toronto, ON M5G 1X5 Canada; Telephone: 416–586‐4800; Fax: 647-776‐3148; E‐mail: [email protected]. It is therefore important that notice is: … There is a similar focus on readmission rates in the province of Ontario. [12] The Ontario Ministry of Health and Long‐Term Care convened an expert advisory panel with a mandate to provide guidance on evidence‐based practices that ensure efficient, effective, safe, and patient‐centered care transitions. Does the pharmacy provide special services such as home delivery, online refills, or medication review and counseling? b. b. Broader recommended changes in practice and policy include: Multiple studies have explored the importance of effective discharge planning and transitional care, and have highlighted the very real benefits in improved patient outcomes and lower rehospitalization rates. You might be handed a list of agencies, with instructions to decide which to use—but often without further information. However this does not mean that the person is now “well” or now has no medical conditions (See the Resources section at the end of this Fact Sheet.) Consent. Congestive heart, failure hospitalization. Our discharge checklist is an expanded tool that provides explicit guidance for each day of hospitalization and can be adapted for any hospital admission to aid interdisciplinary efforts toward a successful discharge. Given the diverse interprofessional membership of the panel, it was felt that a daily reminder of tasks to be performed would provide the best format and have the highest likelihood of engaging team members in patient care coordination. During your stay, your doctor and the staff will work with you to plan for your discharge. [24, 25] Patients with high LACE scores (10) would benefit from postdischarge follow‐up phone calls within the first 3 days of returning home. Third, the checklist has not been tested. Discharge planning is the process by which the hospital team considers what support might be required by the patient in the community, refers the patient to these services, and then liaises with these services to manage the patient’s discharge. A score of 10+ indicates high risk for readmission to hospital.bTeach‐back is the process of explaining information to patients and asking them to restate the information to assess accuracy. What is adult day care and how do I find out about it? We used combined Medical Subject Headings and keywords using patient discharge, transition, and medication reconciliation. Where will the appointment be? Website: www.caregiver.org [28, 35] Just as standardized treatment protocols and care plans can improve outcomes,[36] a similar approach for discharge processes may facilitate safe transition from hospital to home. Has patient received home care? The results of the literature review were circulated prior to the first meeting. That may take some coordination of discharge planning. We believe that discharge planning starts from the day of admission with daily patient education and a coordinated interdisciplinary team approach. Transformation theory is the leadership theory that supports my discharge plan. Effective discharge planning can decrease the chances that your relative is readmitted to the hospital, and can also help in recovery, ensure medications are prescribed and given correctly, and adequately prepare you to take over your loved oneʼs care. My love of 46 years took a turn starting this January. The discharge planning process and the discharge plan must be consistent with the patient's goals for care and his or her treatment preferences, ensure an effective transition of the patient from hospital to post-discharge care, and reduce the factors leading to preventable hospital readmissions. A discharge‐checklist tool was created to facilitate safe discharge from hospital. We describe a structured approach to discharge planning, starting from admission and proceeding through discharge, using a standardized checklist of tasks to be performed for each hospitalization day.OBJECTIVETo create an evidence‐based checklist of safe discharge practices for hospital patients.METHODSIn the province of Ontario, the Ministry of Health and Long‐Term Care convened a panel of expert members from multiple disciplines and across several healthcare sectors. You will need to check directly with the hospital, your insurer, or Medicare to find out what might be covered and what you will have to pay for. Is the building safe (smoke detectors, sprinkler system, marked exits)? The Checklist of Safe Discharge Practices for Hospital Patients summarizes the sequence of events that need to be completed throughout a typical hospitalization. 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