Home Health Coordination Versus Discharge Planning: Where Is the Line? (original) (raw)

ANMCO Position Paper: hospital discharge planning: recommendations and standards

European heart journal supplements : journal of the European Society of Cardiology, 2017

The hospital discharge is often poorly standardized and affected by discontinuity and fragmentation of care, putting patients at high risk of both post-discharge adverse events and early readmission. The present ANMCO document reviews the modifiable components of the hospital discharge process related to adverse events or re-hospitalizations and suggests the optimal methods for redesigning the whole discharge process. The key principles for proper hospital discharge or transfer of care acknowledge that the hospital discharge: • is not an isolated event, but a process that has to be planned as soon as possible after the admission, ensuring that the patient and the caregiver understand and contribute to the planned decisions, as equal partners; • is facilitated by a comprehensive systemic approach that begins with a multidimensional evaluation process; • must be organized by an operator who is responsible for the coordination of all phases of the hospital patient journey, involving af...

[ANMCO Position paper: Hospital discharge planning]

Giornale italiano di cardiologia (2006), 2016

Hospital discharge is often poorly standardized and is characterized by discontinuity and fragmentation of care, putting patients at high risk of post-discharge adverse events and early readmission. The present ANMCO position paper reviews the modifiable components of the hospital discharge process related to adverse events or rehospitalizations and suggests the optimal methods for redesign the whole discharge process. The key principles for proper hospital discharge or transfer of care acknowledge that hospital discharge:- is not an isolated event, but a process that has to be planned immediately after admission, ensuring that the patient and the caregiver understand and contribute to the planned decisions as equal partners;- is facilitated by a comprehensive systemic approach that begins with a multidimensional evaluation process;- must be organized by an operator who is responsible for the coordination of all phases of the hospital patient pathway, involving afterwards the physic...

A Model for Hospital Discharge Preparation: From Case Management to Care Transition

The Journal of nursing administration, 2015

There has been a proliferation of initiatives to improve discharge processes and outcomes for the transition from hospital to home and community-based care. Operationalization of these processes has varied widely as hospitals have customized discharge care into innovative roles and functions. This article presents a model for conceptualizing the components of hospital discharge preparation to ensure attention to the full range of processes needed for a comprehensive strategy for hospital discharge.

Discharge planning: the role of the discharge co-ordinator

Nursing Older People, 2009

Research spanning 30 years has highlighted discharge planning as a complex area of practice. Discharge coordinators are part of the support provided to improve the patient's journey from acute to community settings. The aim of this study was to explore and describe the role of discharge coordinators in a healthcare setting. Using an exploratory descriptive research design a convenience sample of discharge coordinator nurses (n=6) across a variety of acute care settings in the Republic of Ireland, were interviewed. Thematic analysis revealed that the role of the discharge coordinators was multifaceted and a number of factors affected their role. Recommendations for practice include improved discharge planning processes and education. Discharge planning: the role of the discharge coordinator ■ Home care services ■ Multidisciplinary teams ■ Patients: discharge These key words are based on the subject headings from the British Nursing Index. This article has been subject to double-blind review.

Discharge planning: From evidence to practice

Atualmente há uma tendência para precocemente se dar alta hospitalar quer por razões económicas, quer ainda porque o avanço tecnológico o permite. Porém nem sempre o doente tem alta com informação e ensino adequados, e, nem estes foram efetuados com o devido conhecimento não só do meio ambiente habitual do doente mas também das necessidades sentidas por este e pelo seu cuidador. Frequentemente essa tarefa é deixada para a equipe de CSP que também luta com a falta de informação proveniente do hospital. Os Autores baseando-se na sua experiência e em testemunhos relatados por doentes e cuidadores, em sua prática e em investigações anteriores, fazem uma reflexão sobre a alta hospitalar de um doente dependente e sobre a continuidade de cuidados que deve existir entre o hospital e os CSP. Concluem que os cuidados no domicílio após a alta hospitalar trazem dificuldades acrescidas para o doente e cuidadores não imaginadas durante o internamento, e que podem ser em parte, mitigadas pelo acompanhamento da equipe de CSP que prestará uma continuidade de cuidados. Para tal esta precisa de estar devidamente informada pela equipe hospitalar.Também é importante que no planeamento e execução da continuidade de cuidados o paciente e os respetivos cuidadores estejam envolvidos. Desta forma poder-se-á evitar efeitos adversos, por vezes irreparáveis, ou um novo internamento hospitalar não desejado. Palavras-chave: Alta hospitalar; continuidade de cuidados; cuidados domiciliários

Discharge planning: communication, education and patient participation

British journal of nursing (Mark Allen Publishing)

For the most part, discharge from hospital is routine and uneventful. However, for a percentage of people, discharge from acute care requires careful planning to ensure continuity of care. This is particularly the case with older patients who have complex medical needs. This literature review reveals that the essential elements for discharge planning are: communication, coordination, education, patient participation and collaboration between medical personnel. Outcomes measures of successful discharge planning include patient satisfaction and quality of life. Smooth and efficient coordination of this process reduces stress and anxiety for the patient, family, nurse, doctor, hospital and community services.

Discharge Planning from Home Health Care and Patient Status Post-Discharge

Public Health Nursing, 1995

An exploratory study of 57 elderly patients discharged from home health agencies sought to identify how they and their caregivers were prepared for discharge and how they were managing. Data were collected from the home care records and post-discharge interviews with patients and caregivers. Results indicate little evidence of formal discharge planning. However, home care records appear to underreport what home care staff do. On follow-up, over half of the patients had improvement in their health, two-thirds were independent in activities of daily living, and few patients had need of formal services.