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Long Term Health Depends Upon Correct Hospital-to-Home Transition.

By June 20, 2017Discharge Planning

When NASCAR racing teams practice they don’t just think about speed on the track. They also think about speed and accuracy in the pit where seconds matter and races can be won or lost. Handoffs are critical and must be conducted with split-second precision. The same applies to healthcare. The accuracy with which information is handed off to you as your loved one is discharged from the hospital can make all the difference between a successful recovery and re-hospitalization. Here is what you need to know about a successful transfer from hospital to home care.

The Agency for Healthcare Research and Quality (AHRQ) is a national watchdog agency for healthcare in the United States. They have published a guide that sets out the best practices for discharge from hospital to home. The goal is for hospitals to work as partners with patients and their families to improve quality and safety during this transition.

Just like NASCAR, the most important thing during the transition of your loved one from hospital to home is the transfer of care information. According to AHRQ, “The successful transfer of information from clinicians to the patient and family can reduce adverse events and prevent readmissions.”

Upon your loved one’s discharge, the hospital staff should educate you about home care and give you a lot of information. They should discuss the following with you:

  • What life at home will be like when the patient returns.
  • A complete review of medications, dosage, frequency and time of day.
  • Specific focus on warnings signs that the patient is regressing or problems you should watch for.
  • A thorough explanation of test results in terminology that you can understand.
  • A guide to follow-up appointments, what specific doctor or type of doctor they should be scheduled with and when.

Upon discharge, you should also receive a “hospital to home” checklist. If you do not receive one ask for one. Tell the nurse or case manager in the hospital that you want to be as well prepared as possible and that a checklist will help you. If the hospital does not have one, ask the nurse to check with nursing education to see if there is one that can be printed for you.

As the time nears for discharge, use the whiteboard in your loved one’s hospital room to write down your questions. You will be able to keep track of them and the care team will be able to prepare to answer them. Communication between you as the caregiver and the hospital care team will improve your ability to care for your loved one once you are home.

Before you go home, make sure you have all the contact information you need for various members of the care team. There is nothing more frustrating than not being able to reach the right person when you have questions. Some of the staff members for whom you will need contact information include:

  • Primary care physician – day and after hours phone numbers
  • Nurse supervisor
  • Case manager
  • Hospital social worker
  • Physical therapy department
  • Home nursing service
  • Respiratory therapy

If you have been given thorough information, you will be able to provide the level of care needed for your loved one after discharge. You will know what to look for and the conditions that will prompt a call to the physician. If you do not understand how to care for your loved one at home after discharge from the hospital, continue to ask questions until you do. It is the hospital’s responsibility to make sure you fully understand what is required to care for your loved one at home.

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