In addition, we conducted a focused study of select resources, such as the systematic review examining interventions to reduce rehospitalization by Hansen and colleagues,[10] the Transitional Care Initiative for heart failure patients,[14] the Care Transitions Intervention,[15] Project RED (Re‐Engineered Hospital Discharge),[7] Project BOOST (Better Outcomes by Optimizing Safe Transitions),[16] and The King's Fund report on avoiding hospital admissions. Teach patient how to properly use discharge medications and how these relate to the medications patient was taking prior to admission. In the province of Ontario, the Ministry of Health and Long‐Term Care convened a panel of expert members from multiple disciplines and across several healthcare sectors. Follow‐up a.Perform postdischarge follow‐up phone call to patient (for patients with high LACE scoresa). Ask if you should still take these after you leave. facilitated the process (Figure 1). At the first meeting, the panel reviewed existing toolkits and evidence‐based recommendations around best discharge practices. The final checklist describes the processes necessary for a safe and optimal discharge and recommended timeline of when to complete each step, starting from the first day of admission. We believe that discharge planning starts from the day of admission with daily patient education and a coordinated interdisciplinary team approach. The checklist below can help you get started. Example outcome measures, if feasible, include Care Transitions Measure (CTM) scores, patient satisfaction surveys, and readmission rates. Second, the heterogeneity of interventions studied pose challenges in determining generalizable best practices without considering local factors. Following the meeting, each group communicated via e‐mail to generate a list of evidence‐based items necessary for a safe discharge within the context of the group's assigned lens. Bibliographies of all relevant articles were reviewed to identify additional studies. Patient identifies if family or friends need to be involved. As well, our paper follows an explicit and defined consensus process. Our discharge checklist is an expanded tool that provides explicit guidance for each day of hospitalization and can be adapted for any hospital admission to aid interdisciplinary efforts toward a successful discharge. Halasyamani and colleagues developed a checklist for elderly inpatients created through a process of literature and peer review followed by a panel discussion at the Society of Hospital Medicine Annual Meeting. This website uses cookies to improve your experience. There is a similar focus on readmission rates in the province of Ontario. There is a similar focus on readmission rates in the province of Ontario. Teach‐back is the process of explaining information to patients and asking them to restate the information to assess accuracy. We have used a consensus process of stakeholders to develop a Checklist of Safe Discharge Practices for Hospital Patients that details the steps of events that need to be completed for every day of a typical hospitalization. Do I understand which treatment I need now - and in the future? helps to make sure that you leave the hospital safely and smoothly and get the right care Patient education a. Make sure there are fresh groceries at home in preparation for discharge. The checklist domains include (1) indication for hospitalization, (2) primary care, (3) medication safety, (4) follow‐up plans, (5) home‐care referral, (6) communication with outpatient providers, and (7) patient education. Institutions may consider measuring process measures such as adherence and completion of checklist, audits of discharge summaries for completion and transmission rates to PCPs (by fax or through health record departments), and documentation of patient education or medication reconciliation. Formal medication reconciliation programs should be tailored to the individual hospital's own resources and requirements. These discharges often result in patient injury (and extreme cases, death), … For example, PCPs in group 1 were asked to consider an ideal discharge from the perspective of primary care. A score of 10+ indicates high risk for readmission to hospital. [13] The objective of this study is to describe a structured panel approach to safe discharge practices, including a checklist of a recommended sequence of steps that can be followed throughout the hospital stay. A discharge‐checklist tool was created to facilitate safe discharge from hospital. This checklist is a tool to promote optimal adherence to the processes and practices outlined as guidance and proposed updates to the CMS Discharge Planning Conditions of Participation. This differs significantly from our discharge checklist, which provides specific recommendations on methods and processes to effect a safe discharge in addition to an expected timeline of when to complete each step. A discharge‐checklist tool was created to facilitate safe discharge from hospital. The Checklist of Safe Discharge Practices for Hospital Patients summarizes the sequence of events that need to be completed throughout a typical hospitalization. a. Do I understand what happened in hospital? Hospital Discharge Checklist Here are ten important things to consider when preparing for a hospital discharge: 1.Safety – Is your home a safe place for your recovery? The panel chose daily reminders to perform patient education around medications and clinical care for several reasons. Bring this information and your completed “My Drug List” to your follow-up appointments. Bibliographies of all relevant articles were reviewed to identify additional studies. Institutions may consider measuring process measures such as adherence and completion of checklist, audits of discharge summaries for completion and transmission rates to PCPs (by fax or through health record departments), and documentation of patient education or medication reconciliation. The panel reached 100% agreement on the recommended timeline to implement elements of the discharge checklist. Communication a. Standard hospital newborn tests and procedures after birth Erythromycin eye ointment; Vitamin K injection; Hepatitis B vaccine; New born bath Hospital newborn tests and procedures before discharge. Contact PCP and notify of patient's admission, diagnosis, and predicted discharge date. Explain to patient how new medications relate to diagnosis. You can take this checklist with you, and share it … Ask if you will need medical equipment (like a walker). We believe that discharge planning starts from the day of admission with daily patient education and a coordinated interdisciplinary team approach. 3. Standardizing discharge planning and initiating processes early on in a patient's hospital stay may ensure a safe transition home. Every group reached consensus on items specific to its context. We describe a structured approach to discharge planning, starting from admission and proceeding through discharge, using a standardized checklist of tasks to be performed for each hospitalization day.OBJECTIVETo create an evidence‐based checklist of safe discharge practices for hospital patients.METHODSIn the province of Ontario, the Ministry of Health and Long‐Term Care convened a panel of expert members from multiple disciplines and across several healthcare sectors. Ask for written discharge instructions (that you can read and understand) and a summary of your current health status. Although education starting on day 1 of admission may seem premature, we felt there was merit in addressing issues early. c. Book postdischarge PCP follow‐up appointment within 714 days of discharge (according to patient/caregiver availability and transportation needs). [3] The expert panel agreed on admission notification, follow‐up appointment scheduling, and transfer of a high‐quality discharge summary to the patient's PCP, such as one described by Maslove and colleagues. [2, 26, 27, 28] The discharge checklist provides prompts to reconcile medications on admission and discharge, in addition to daily patient education on proper use of medications. [3] Use of validated scores such as the LACE index (a score calculated based on 4 factors: [L] length of hospital stay, [A] acuity on admission, [C] comorbidity, and [E] emergency department visits) to identify patients at high risk of readmission and targeting these individuals when arranging postdischarge follow‐up is encouraged. To mitigate this, we suggest adapting the checklist to local contexts and resource availability. We have used a consensus process of stakeholders to develop a Checklist of Safe Discharge Practices for Hospital Patients that details the steps of events that need to be completed for every day of a typical hospitalization. [29, 30]. Check if you have sufficient money with you for the first few days out of hospital. A preliminary draft checklist was produced based on input from all groups. Has my GP been informed of my admission and of my discharge plan? The Checklist of Safe Discharge Practices for Hospital Patients summarizes the sequence of events that need to be completed throughout a typical hospitalization. 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Discharge planning begins early in your hospital stay. The next step of this project is to pilot checklist use through small‐scale Plan‐Do‐Study‐Act (PDSA) cycles followed by large‐scale implementation. It was also felt that daily interdisciplinary (ie, bullet) rounds would serve as the most appropriate venue to utilize the checklist tool.Table 1.Checklist of Safe Discharge Practices for Hospital Patients Day of AdmissionSubsequent Hospital DaysDischarge DayDischarge Day +3NOTE: Abbreviations: BPMH, best possible medication history; ED, emergency department; LTC, long‐term care, PCP, primary care physician.aLACE index is a score calculated based on 4 factors: (L) length of hospital stay, (A) acuity on admission, (C) comorbidity, and (E) ED visits. Required fields are marked *. In addition, this checklist was designed to integrate discharge planning into interprofessional care rounds occurring throughout a hospital admission. c. If necessary, schedule postdischarge care. This is called a discharge plan. In addition, we conducted a focused study of select resources, such as the systematic review examining interventions to reduce rehospitalization by Hansen and colleagues,[10] the Transitional Care Initiative for heart failure patients,[14] the Care Transitions Intervention,[15] Project RED (Re‐Engineered Hospital Discharge),[7] Project BOOST (Better Outcomes by Optimizing Safe Transitions),[16] and The King's Fund report on avoiding hospital admissions. A preliminary draft checklist was produced based on input from all groups. Finally, our proposed tool better follows a recommended checklist format. The aim was to create a discharge checklist to aid in transition planning based on best practices.Checklist‐Development ProcessAn improvement consultant (N.Z.) During the meeting, panel members were assigned to 1 of 6 groups (based on specialty area) and instructed to review toolkits and literature using a context‐specific lens (primary care, home care, follow‐up plans, communication to providers and caregivers, medication, and education). We suggest using the checklist during daily interprofessional team rounds to ensure each task is completed, if appropriate. [21] The second meeting provided the opportunity for individual comments and feedback on the draft checklist. Hospital Leave a comment 565 Views. The results of the literature review were circulated prior to the first meeting. This checklist was created by patients for patients who have been in hospital for COVID-19 treatment. Ask the staff about your health condition and what you can do to help yourself get better. 2. Third, the checklist has not been tested. Hospital to identify staff to be involved in meeting, for example the nurse, doctor, patient advocate, discharge planner, or a combination. Second, the heterogeneity of interventions studied pose challenges in determining generalizable best practices without considering local factors. To facilitate transfer of information, patients, caregivers, outpatient providers, and community pharmacies are to be provided copies of a comprehensive discharge summary, medication reconciliation, and contact information of the inpatient team under the category of Communication. Ask where you will get care after discharge. Has patient received home care? The next step of this project is to pilot checklist use through small‐scale Plan‐Do‐Study‐Act (PDSA) cycles followed by large‐scale implementation. For example, patients admitted with heart failure can benefit from daily inpatient education around self‐monitoring, diet, and lifestyle counseling. The final checklist describes the processes necessary for a safe and optimal discharge and recommended timeline of when to complete each step, starting from the first day of admission. Good planning helps you feel prepared for discharge, and helps you to continue your recovery once you leave the hospital. Coordinating discharge care requires significant teamwork; our tool extends beyond a checklist of tasks to be performed, and rather serves as a platform to facilitate interprofessional collaboration. [4, 5, 6] Discharge bundles (multifaceted interventions including patient education, structured discharge planning, medication reconciliation, and follow‐up visits or phone calls) are strategies that provide support to patients returning home and facilitate transfer of information to primary‐care providers (PCPs). Write down a name and phone number to call if you have questions. b. It can help you feel ready for the conversation you’ll have with your circle of care in a few days about your discharge home. http://www.health.gov.on.ca/en/common/ministry/publications/reports/bake... http://www.kingsfund.org.uk/publications/articles/avoiding. [13] The objective of this study is to describe a structured panel approach to safe discharge practices, including a checklist of a recommended sequence of steps that can be followed throughout the hospital stay. If necessary, arrange outpatient investigations (laboratory, radiology, etc.). Several limitations of this study should be considered. a. Kripalani et al reviewed the literature for suggested methods of promoting effective transitions of care at discharge, and their results are consistent with those summarized in our discharge checklist. Hospital/hospice staff must prioritise the discharge as URGENT to minimise any potential delays. a.Perform postdischarge follow‐up phone call to patient (for patients with high LACE scores. Save my name, email, and website in this browser for the next time I comment. Arrive at the hospital two hours before surgery; Bring all documents as instructed; Register in room M-wing, ground floor, room 502; After surgery: Deep breathing and coughing; Pain control; Prescription; Follow-up appointment; Discharge teaching by nurse; Discharge home in _____ days; Download this checklist Given the diverse interprofessional membership of the panel, it was felt that a daily reminder of tasks to be performed would provide the best format and have the highest likelihood of engaging team members in patient care coordination. Ask if you’re ready to do the activities listed below. To create an evidence‐based checklist of safe discharge practices for hospital patients. The panel conducted a systematic search of the literature and used a structured approach to review evidence‐based practices that ensure efficient, effective, safe, and patient‐centered care transitions. Use this checklist to help you, your family and the hospital staff plan your safe discharge. Write down ALL your prescription drugs, over-the-counter drugs, vitamins, and herbal supplements: Tell the staff what drugs, vitamins, or supplements you took before you were admitted. c. Thoroughly explain discharge summary to patient (use teach‐back if needed). During your stay, your doctor and the staff will work with you to plan for your discharge. Assess patient’s ability and access to use virtual communication services for follow up and home care supports. [29] In contrast to both efforts, our group was multidisciplinary and had broad representation from the acute care, chronic care, home care, rehabilitation medicine, and long‐term care sectors, thereby incorporating all possible aspects of the transition process. c. Reconcile discharge medication order/prescription with BPMH and medications prescribed while in hospital. The goal of this exercise was to ensure that elements necessary for a successful discharge were viewed through the perspectives of interprofessional groups involved in the care of a patient. Ask about problems to watch for and what to do about them. • Talk to your doctor and the staff (like a discharge planner, social worker, or nurse) about the items on this checklist. To develop a best‐practice discharge checklist for hospital patients using the Electronic Medical Record (EMR) (EPIC, Verona, WI), and evaluate its usage, user‐satisfaction, and impact on physicians’ workflow. b. Provide patient, community pharmacy, PCP, and formal caregiver (family, LTC, home‐care agency) with copy of Discharge Summary Plan/Note and the Medication Reconciliation Form, and contact information of attending hospital physician and inpatient unit. Multifaceted “discharge bundles” facilitate care transitions and possibly decrease adverse outcomes. 4. Although education starting on day 1 of admission may seem premature, we felt there was merit in addressing issues early. 6. Coordinating discharge care requires significant teamwork; our tool extends beyond a checklist of tasks to be performed, and rather serves as a platform to facilitate interprofessional collaboration. http://www.who.int/patientsafety/implementation/solutions/high5s/en/inde... http://www.psnet.ahrq.gov/primer.aspx?primerID=14, Choosing Wisely: Things We Do For No Reason. The group avoided specific detailed recommendations to allow each institution to locally tailor appropriate process and outcome measures to assess fidelity of each component of the checklist. DISCLOSURES Speakers have no conflicts of interest to disclose. Figure 1 The checklist‐development process. Standardizing discharge planning and initiating processes early on in a patient's hospital stay may ensure a safe transition home. Given the diverse interprofessional membership of the panel, it was felt that a daily reminder of tasks to be performed would provide the best format and have the highest likelihood of engaging team members in patient care coordination. Can you give the patient the help he or she needs? [34] The resultant tool described important data elements necessary for a successful discharge and which processes were most appropriate to facilitate the transfer of information. This site uses Akismet to reduce spam. [20] were examined in detail. For those without a PCP, it was recommended that a search should be initiated to assist the patient in obtaining a PCP.Medication safety is a significant source of adverse events for patients returning home from the hospital. [34] The resultant tool described important data elements necessary for a successful discharge and which processes were most appropriate to facilitate the transfer of information. Things to do before you go home. The transition from hospital to home can expose patients to adverse events during the postdischarge period. [29, 30]Postdischarge care plays an important role in supporting the patient upon discharge and when part of a multifaceted discharge plan can result in decreased readmission rates and hospital utilization. Multifaceted “discharge bundles” facilitate care transitions and possibly decrease adverse outcomes. 5. A final meeting provided consensus of the panel on every element of the Safe Discharge Practices Checklist. The transition from hospital to home can expose patients to adverse events during the postdischarge period. The UK’s 100 favourite books in 2015 Checklist. The Top 10 Wedding Planning Checklists Book PDF. Discharge from hospital can be a vulnerable period for patients. The instructor then repeats the process until the patient demonstrates correct recall and comprehension.1. Our discharge checklist is an expanded tool that provides explicit guidance for each day of hospitalization and can be adapted for any hospital admission to aid interdisciplinary efforts toward a successful discharge. For example, PCPs in group 1 were asked to consider an ideal discharge from the perspective of primary care. The day of discharge is often a confusing and chaotic time, with patients receiving an overwhelming volume of information on their last day in the hospital. Do you have any questions about the items on this checklist or on the discharge instructions? Discharges are based on hospital need for beds and not the doctor or nurses’ projections. a. Home‐care agency shares information, where available, about patient's existing community services. We plan to collect baseline, process, and outcome measures before and after implementation of the checklist at multiple institutions to determine utility.Standardization of discharge practices is critical to safe transitions and preventing avoidable admissions to hospital. Kripalani et al reviewed the literature for suggested methods of promoting effective transitions of care at discharge, and their results are consistent with those summarized in our discharge checklist. We plan to collect baseline, process, and outcome measures before and after implementation of the checklist at multiple institutions to determine utility. [24, 25] Patients with high LACE scores (10) would benefit from postdischarge follow‐up phone calls within the first 3 days of returning home. b. The panel met 3 times in person over a period of 3 months, from January 2011 to March 2011. Newborn metabolic screen; Circumcision (if requested) … The panel chose daily reminders to perform patient education around medications and clinical care for several reasons. Daily teaching provides an opportunity to assess information carried over and accurate understanding of treatment plans, as well as to review changes in care plans that may be evolving during a hospitalization. 6. facilitated the process (Figure 1). © 2013 Society of Hospital Medicine. Develop BPMH and reconcile this to admission's medication orders. During the meeting, panel members were assigned to 1 of 6 groups (based on specialty area) and instructed to review toolkits and literature using a context‐specific lens (primary care, home care, follow‐up plans, communication to providers and caregivers, medication, and education). Here are some questions you could ask yourself before you are discharged from hospital: 1. [28, 35] Just as standardized treatment protocols and care plans can improve outcomes,[36] a similar approach for discharge processes may facilitate safe transition from hospital to home. Our discharge checklist prompts hospital providers to initiate steps necessary for a successful discharge while allowing for local adaptation in how each element is performed. Find inspiration for your hospital to undertake discharge … For example, only 50% of patients have complete resolution of their congestive symptoms at hospital discharge. [10] Individual items of the checklist may not have had an extensive evidence base; however, some of these suggested elements (eg, contact home care) have clinical face validity. Future studies to evaluate the checklist in improving care‐transition processes are required to determine association with outcomes. Download the checklist here. a. Hospital Discharge Checklist. Write down any appointments and tests you will need in the next several weeks. 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