In our fast-paced and ever changing world, medical personnel face the challenge of providing quality and personal care to a vast number of patients. With the number of people being treated in hospitals increasing, it is very important for the discharge process to be as smooth and informative as possible. Breakdowns in communication between facilities and caregivers during hospital discharge processes can cause serious and sometimes life-threatening situations, and in recent years several resources have been created to prevent such situations from occurring.
The National Transitions of Care Coalition was created in 2006 as part of a joint effort between the Case Management Society of America (CMSA) and Sanofi U.S. The coalition was founded to address gaps that impact safety and quality of care for transitioning patients and to pose solutions to fill these gaps. The web site is www.ntocc.org, and includes information for consumers on guidelines for a hospital stay, keeping track of medication, a patient bill of rights during transitions of care, and patient safety. For health care professionals there is information on cultural competence, health information technology, transitions of care policies, and helpful checklists. There are also sections for policy makers and the media, along with links to past press releases and news. Information can be found on upcoming and recent events and conferences, membership opportunities, and the governing bodies. Some of the documents are available in Spanish and French.
The Institute for Healthcare Improvement is based in Cambridge, Massachusetts, and has existed for over 25 years. It offers a variety of continuing education opportunities for health care professionals, including conferences, seminars, and workshops in various locations around the world. The site has links to several user groups and blogs that can be searched according to interest, as well as a link to its free weekly newsletter. There are resources on a variety of topics regarding care transitions, and readers must register with the site in order to access some of these. The web site is www.ihi.org.
The Care Transitions Program aims to support patients and their families, help healthcare providers sharpen their skills, use technology to promote effective information exchanges from one care setting to another, improve safety and quality at systematic levels, create tools to measure performance and means of reporting to the public, and affect national policy change. The web site, www.caretransitions.org, includes a video entitled "Survival Skills for Leaving the Hospital," a discharge checklist, a medication discrepancy tool, and information for family caregivers, among other tools. This site contains information about the Care Transitions Program, which is a comprehensive 4-week program in which patients and family members work with a "Transitions Coach" to learn self-management skills to create a smooth transition from the hospital to their home. Some tools are available in Spanish, Russian, Chinese, Hebrew, French, Finnish, and Malay.
Project BOOST is an initiative of the Society of Hospital Medicine and stands for Better Outcomes by Optimizing Safe Transitions. The web site is www.hospitalmedicine.org/BOOST, and is geared towards hospitals and other medical facilities, providing tools for facilities to improve their discharge procedures. Project BOOST offers a mentoring program for facilities, as well as professional development opportunities for health care professionals. There is information on best practices, tracking tools, and a guide to implement their programs.
Project RED stands for Re-Engineered Discharge, and is based out of Boston University's School of Medicine. The group comes up with strategies to help hospitals discharge patients in a safe way and to minimize the need for patients to return to the hospital. The Project RED Tool Kit explains reasons a facility should re-engineer their discharge process, and explains the steps to do so. The web site, www.bu.edu/fammed/projectred/ and includes an After-Hospital Care Plan and provides detailed information on safe discharge.
The Integrating Care for Populations and Communities (ICPC) site is oriented toward Medicare Quality Improvement Organizations (QIOs), and offers information on care transitions. The organization seeks to bring together those who are stakeholders in community coalitions including patient advocacy organizations, nursing homes and hospitals. The web site is http://www.cfmc.org/integratingcare/.
The United States Department of Health and Human Services has a page on preventing avoidable readmissions, including tools for patients and health care providers: http://www.ahrq.gov/legacy/qual/impptdis.htm.
The Family Caregiver Alliance National Center on Caregiving (http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=2312) provides information and tools for discharge planning.
Each of these resources can provide assistance to those who facilitate the discharge of patients from hospitals into care facilities or other post-hospitalization care solutions.
About the Author
Christy Rakoczy has a JD from UCLA School of Law and an undergraduate degree in English Media and Communications from University of Rochester. Her career background includes teaching at the college level as well as working in the insurance and legal industries. She is currently a full-time writer who specializes in the legal, financial and healthcare sectors. Ms. Rakoczy writes online content as well as textbooks for adult learners.