Managing Transitions of Care
The cases of Mrs. Cado and Mr. Ransyshyn illustrate complex transitions of care where advanced assessment skills and discharge coordination are required. Emerg physicians tend to think of their sphere of care as being limited to the ED but we are often the managers of care as patients move “through” our department. We interact with both the “upstream” (where the patient is coming from) and “downstream” (where the patient is going.)
Definition
A transition of care is any time a patient moves from one site of care to another:
- From home to the ED;
- From ED to home;
- From the family doctor’s office to the ambulance crew;
- From the long-term care doctor to the Emerg physician;
- From the Emerg nurse to the community care agency who is providing follow up care;
- From the emerg physician to the inpatient surgeon.
Emerg physicians know how complex , complicated, and loaded with risk it is even to transfer care of a straight forward patient in our own ED from one Emerg physician to another. The EM literature is full of studies of “hand-overs” as a source of medical error.
The assessment and disposition of a complicated vulnerable older person is far more complex. Older patients can be cognitively or functionally impaired, with a new or poorly understood condition, sometimes with three or more care providers, and a significant change in function, cognition, or social situation.
Emerg physicians need to have a large toolbox of strategies to minimize the risk of harm and to maximize the quality of care to older patients as they move through our EDs.
Discussion: Managing Transitions of Care
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Coomunication is key
ok
need complete communication
proper handoff = good communication!
ok
ok
okay
i9j
ok
ok
ok
agree
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L
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increased communication should be a goal of ED docs for better patient care
good communication b/w all caregivers.
agreed
agree
Noted
good information
good information
adietrich
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yes
good point
yes, complex thing
often underestimated
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Agree
I agree with this
clear information
Good cmmunication
we’ve had much improvement from our NH over the last 6 months and now receive a fairly complete written/typed transfer report.
agree
I also agree
great
insightful
okay
agree
yes
agree that if hand off does not occur, patient suffers
Agree
yes
oaky
transition of care is just as important
agree
agree
placement comes first
transition of care is important
proper hand over format is needed, there needs to be consistency with the care of plan when discharging patients. there needs to be communications between facilities
The transition of care from one health care provider to the other is an important event. Detailed information from multiple sources is required for comprehensive geriatric assessment and should always be handed over in detail among health care providers in elderly patients. The literature also supports maximum risk of medication errors is during transition of care.
transition of care is an important aspect of client centered care
Depending on patient to remember everything at discharge is risky, ensuring smooth transition important
Upstream and downstream effective communication is imperative, however, it is often our downfall.
I think things are changing since ontario health record are available now in all level, helpful for planning the careplan
Agree +++
Agree
In Uk we have specialized Care of Elderly consultants in ED along with very experienced physiotherapists, occupational therapists, social workers and discharge coordinator nurses. inorder for us to achieve transition of care safe and effective
information is key , from family , and or care facility . pt’s cognitive abilities are a necessary tool on pt safety and care .
a document that is standardized is only as compleat as its author. Vague c/o records may be a reflection of staffing levels or abilities within a nursing home, and the request information s brushed a side withthe preception that the home physician will call the er doc. NEVER yet done that I have seen….
clear information
todo lo que sea educación nunca es excesivo
perfecto
legible information is very important.
🙂
I agree Abufayed
food
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I think most of the frustration comes from lack of proper and clear communication between healthcare providers.
I often receive poor transfer of care information from LTC, and as a result, am not that motivated to go the extra mile to provide the info back to LTC. I need to put that frustration aside, and do what’s best for the patient, and use all venues to ensure good communication of the care plan.
agree with above comments regarding clear, legible documentation both sending patient out and receiving a patient.
Receiving adequate “handover” info when a patient is returned to LTC from the ER or hospital admission is an ongoing frustration, and it limits the ability to provide the best care possible in LTC. Good communication and handover does take some time, but it is very important for quality care. It is a two-way street, with communication from the LTC to the ER when a patient is transferred also being important.
i agree the more comprehensive and direct the handover the better the management of patients,perhaps a handover format that contains the most pertinent information can be used