Participants should be aware of the following financial/non-financial relationships:
Kathleen D. Weissberg, MS, OTD, OTR/L, CMDCP, CDP, CFPS: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Challenged by transfers of care between hospitals and post-acute care facilities? You are not alone. Administrators and nursing leadership in both settings struggle. What previously required only a few key pieces of information about a patient has evolved into a complex process with multiple opportunities for failure. Risks exist that are associated with inaccurate or incomplete transfer of information affecting resident and patient safety, resulting in the potential for harm. The goal is to provide quality care while preventing hospital readmissions. Readmissions are not only costly to the providers resulting in financial penalties, but equally as costly to the patient. Readmissions can be traumatic, affecting health outcomes, morbidity and even mortality. In a recent study published in the Journal of Hospital Medicine that explored the perspective of patients related to readmission, 28% reported not feeling ready for their discharge and 56% never phoned their physician before returning to the hospital. This brings up the question: are our discharge processes and protocol adequate? Are we doing everything we can to prepare our patients for a successful discharge? It is clear that reliable communication between all parties is paramount for effective transfers. But what are the best practice guidelines related to this? In this session, risk areas related to transfers between post-acute settings will be reviewed along with practical strategies providers can implement to mitigate this risk.
Learning Objectives:
Identify risk areas related to transfers between post-acute settings.
Discuss the negative effects on quality and safety surrounding transitions in care.
Describe the "warm hand-off" and how the interdisciplinary team utilizes this approach in transfers of care.
Identify strategies to manage transitions of care to proactively identify, prioritize, and mitigate potential uncertainties.