For sufferers, each transition of care to a different establishment carries the chance of issues.

For instance, when a affected person strikes from a hospital to a follow-up care facility, important affected person data similar to medical historical past and medicine lists will be misplaced, missed, or not shared. This could result in therapy delays and suboptimal care.

Like many issues in life, profitable transitions of care usually start with sturdy communication. To match sufferers with probably the most acceptable amenities for his or her circumstances, hospital case managers will need to have environment friendly processes in place to establish the suitable post-acute associate for the transition and perceive whether or not that associate is now at capability.

Nevertheless, employees on each the delivering and receiving ends of affected person transfers are sometimes overburdened with administrative processes and technological inefficiencies that hinder and stop them from doing higher-value medical work. For instance, a hospital case supervisor should ship faxes and make telephone calls to a number of nursing amenities (SNFs) inside the hospital's community to establish which facility is finest ready to simply accept a specific affected person.

To beat these limitations related to post-acute affected person transfers, many suppliers are adopting post-acute placement expertise that’s primarily based on finest practices and surrounded by a community of engaged suppliers. By streamlining most of the core processes related to transitions of care, these options allow well being methods to enhance affected person move and throughput, improve the affected person expertise, scale back wait occasions, and allow useful and scarce medical employees to carry out on the most capability of their licenses.

Why discharge planning must be improved
There are quite a few inefficiencies that may disrupt the hospital discharge course of, together with challenges matching sufferers to acceptable service ranges, staffing shortages, and points with affected person insurance coverage. When these points come up, they can lead to longer-than-necessary affected person stays, a expensive drawback for hospitals. For instance, lowering avoidable days saves suppliers greater than $3,000 per day for every affected person, whereas releasing up capability for sufferers ready within the ED, PACU, or in a facility that requires a better stage of care transition.

Discharge to SNF, the most typical post-acute referral, is an usually inefficient course of leading to hours or days of delay. Many of those points stem from poor orchestration between care groups and a scarcity of standardized affected person transition processes and workflows. Widespread causes of delays embody points with insurance coverage authorization, SNF approval response time, partaking acceptable suppliers, timeliness of recognizing the necessity for SNF and initiating the method, and arranging for transportation.

Along with improved communication between referring and accepting amenities, the elevated effectivity supplied by referral and placement expertise permits bedside employees to dedicate extra time and a focus to affected person care and communication. That’s necessary as a result of improved discharge communication results in higher affected person outcomes, based on a 2021 overview and meta-analysis revealed in JAMA Open Community.

Certainly, the examine discovered that discharge communication interventions had been considerably related to decrease readmission charges (9.1% vs. 13.5%), larger adherence to the therapy routine (86.1% vs. 79.0%), and better affected person satisfaction (60.9% vs. 49.5%). Whereas discharge communication straight with the affected person drives most of those success charges, post-acute care suppliers should even be well-informed in order that they are often accountable for delivering the meant outcomes. Subsequently, well timed communication of related data from the hospital to the post-acute care supplier needs to be relayed with the identical intentionality as with the affected person.

3 Methods Publish-Acute Placement Options Enhance Transition of Care
Whereas there are quite a few advantages for well being methods when implementing options that enhance the transition to post-acute care, the next three stand out as crucial:

1. Much less administrative burden – Trendy expertise helps hospital case managers get rid of most telephone calls and faxes to post-acute care suppliers and automates transport coordination to encourage earlier discharges. Because of this, staff are free of mundane, repetitive duties to carry out optimally of their coaching, rising employees satisfaction.

2. Larger operational effectivity – By gaining a system-wide view of post-acute community efficiency, well being methods can enhance widespread operational processes throughout care administration groups. Well being system leaders can then use this 360-degree view of community efficiency to have extra productive conversations with post-acute suppliers and finally enhance the curation of their networks, leading to an environment friendly, high-performing community that may be a true associate to the well being system.

3. Higher affected person care – By beginning the post-acute placement course of earlier, well being methods speed up the timeline to discharge, permitting sufferers to obtain the care and therapy they want in the suitable atmosphere sooner. With extra environment friendly, efficient, and complete communication between hospital case managers and post-acute care representatives, sufferers usually tend to transition efficiently, permitting them to return to their communities.

Traditionally, transitions of care have usually been fraught with considerations about threat and uncertainty, however many well being methods are implementing post-acute placement finest practices and expertise to enhance the method. By lowering administrative burden and driving higher operational effectivity, post-acute placement affected person move leads to higher experiences for sufferers, suppliers, and employees.

About Lane Clever

Lane Clever joined ABOUT Healthcare in 2019 as Director of Buyer Success, bringing with him over 20 years of medical expertise in healthcare and affected person care. Lane is a confirmed chief in healthcare and has been profitable in delivering medical consulting and steady enchancment initiatives with shoppers.
Previous to becoming a member of ABOUT Healthcare, Lane was Director of Affected person Navigation at PHI Well being. Earlier than that, he held nursing and allied well being management roles at West Tennessee Healthcare.