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Hospital Med > Transitioning Care > Flashcards

Transitioning Care Flashcards

1
Q

what is the discharge portion of this lecture

A

last 1/3 - this is where the assignment is (this is the most important part)

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2
Q

What is the first and most signifant transition of a patient care?

A

Hospital admission

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3
Q

Goals and risk of emergency department

A

transfer of info and clarify who will be taking care of patient
risk: delay of info

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4
Q

What is the principal diagnosis vs problem list

A

main diagnosis and problems that they have

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5
Q

What info is given to ED

A

Principal diagnosis
diagnosis list
cognitive status
test results

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6
Q

what additional info may be requested for a transfer of care

A

level of inpatient care
level of admitting service
timing to obtain critical info
ED boarding (can take time)

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7
Q

If a patient comes from an office, what is this called?

A

Direct admissions

not typically done (as it is complex)

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8
Q

Direct admissions pros/cons

A

saves hours
saves overcrowding

sometimes stable in office, but may crash so this can be dangerous

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9
Q

What are some recommendations for direct admissions

A

stable
admitting diagnose is clear
evaluated the DAY of

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10
Q

What is the clear communication between the PCP and the hospitalist

A

rationale
diagnosis
labs

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11
Q

Prior to transfer
during transfer
after transfer

problems

A

Prior to transfer: delay in communication d/t going from a small center to large one. Difficult to find a bed. Inappropriate transfer because they went to the wrong center.

during transfer: decompensation as movement from one facility to the next may not have the correct

after transfer: discontinue the care plan causing delay, unnecessary testing increase bill, no shared EMR

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12
Q

What is the complicated patient

A

skill nursing facility

very hard patients to treat

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13
Q

Post form

A

tells the code status - full code, DNR, wishes for IV AB

basically what the patient wants

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14
Q

What is the emergency department

A
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15
Q

Do patients leave the ED immediately after being admitted?

A

NO

can lead to a lot of issues
should plan for shift changes with a large admitting team to save time
sometimes PAs are there just to transfer care

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16
Q

Can you held liable for patient care during transfer even if they are not at your facility

A

YES

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17
Q

Outpatient VS Inpatient status is determined by

A

CMS and insurance

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18
Q

___ midnight rule

A

2 midnight rule = if they are expected to be there LESS than 2 midnights that will be outpatient. If AT LEAST 2 midnights then inpatient.

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19
Q

Do we prefer inpatient or outpatient

A

inpatient for money

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20
Q

if they have an acute on chronic, then what is it likely going to be?

A

Outpatient

stent placement is also outpatient

21
Q

What units do patients go to if they don’t need cardiac monitoring?

A

Med/surge

lower critical patients

22
Q

What is a telemetry unit

A

more frequent monitoring every 4 hours

have cardio techs

23
Q

what is an intermediate care unit

A

treated like intensive care, but NO critical care MEDS

24
Q

What is intensive care units?

A

Broken down based on organ system

may transfer from one unit to another

25
Q

Who needs telemetry

A

CC of chest pain
Some1 coming in with cardiac history
Stroke patient that cannot maintain airway
Patients with sepsis criteria

telemetry SHOULDNOT replace frequent observation and assessment of a patient

26
Q

How often should telemetry patients be reevaluated?

A

DAILY

27
Q

What is the handoff process?

A

Fluid dynamic exchange, discharge.

Subject to distraction and interruptions.

28
Q

What are types of intrahospital handoffs?

A

Shift change: transfer of care between one shift to another.
Service change: written documentation, permemant transition that will assume care to another team.
Service transfer: care of one group of clinicians to another care of professionals.

29
Q

What are the core components of handoffs?

A

Verbal communication: build shared mental model for patient.
Written communication: typically just the note.
Transfer of professional responsibility

30
Q

What are the core steps of the handoff process

A

Pre-handoff
arrival
Dialogue
Post-handoff

31
Q

What are the two standardized handoffs

A

IPASS and SBAR

32
Q

IPASS

A

Introduction
Patient identification
Assessment
Situation
Safety concerns

33
Q

SBAR

A

Situation: what’s going on with the patient?
Background: relevant history
Assessment : what do you think is going on
Recommendation: what are you going to do

Nurse and provider does this

34
Q

What is hospital discharge

A

Vulnerable times for patient
Adverse outcomes common (50% have medical error and 20% have adverse event)

goal is to make sure that the discharge is adaptive

readmission is troublesome (hospital administration may single you out)

35
Q

What are some unsucessful discharge transition?

A

Premature discharge (patient leaves or providers think they are stable)
Inappropriate discharge setting: do not have resources
Poor social support or low literacy
Specific clinical conditions: CHF (fluid problems) or psych comorbidities
Inadequate handoffs: pending tests
Delayed or unscheduled f/o
Lack of advanced care planning
Failure to ensure comprehension
Medication-related problems

36
Q

What are key elements of discharge care coordination

A

Appropriate destination
Proactive f/o appointments
Careful med reconciliation
Engagement of patients and caregivers

Be proactive!

37
Q

Choosing a discharge destination

A

Make sure that the needs are met to services

MC is home w/ or w/out caregivers
Home with home health services (preferred)
Inpatient rehab facility
Skilled nursing facility (SNF) for PT or OT

38
Q

How often does a provider need to see a patient at a skilled nursing facility

A

only once every 30 days!

39
Q

For scheduling f/o appointments what is important

A

Appointments need to be made BEFORE the patient leaves the hospital

Often times patients will be too busy and health care providers can also get sick

40
Q

When should a patient f/o?

A

Severity of illness
Comorbidites

41
Q

When should patients f/o with PCP after discharge?

A

One week, sometimes two

sometimes 48 hours if really concerned, but not realistic

42
Q

What should be given after discharge?

A

RED FLAGS

43
Q

What is a medication reconciliation and who is in charge of this?

A

Med list is obtained, compared and clarified

evaluate polypharmacy
screens for high alert drugs and drug/drug interactions

should say meds are added, continued, or changed

Starts with you, but requires multidisciplinary approach!

44
Q

What is some patient engagement and education?

A

Teach back method with patient (often done by nurses)
Patients only remember about half of info
Perform small sessions of recap so that they are not overwhelmed

45
Q

What should discharge include

A

Reason for hospital
Pertinent results
meds
diet and activity
follow-up appointments

46
Q

What is the handoff discharge summary

A

needs to be detailed to make sure PCP knows what happens

needs to be done by 30 days, but on you after 15 days

47
Q

Components of discharge

A

Primary 2ndary diagnoses
test results
pending results
recommendations
patient condition
complete list of meds
f/o
identification of

48
Q

56 yo male with CP, 2 hours ago, substernal area. HTN, HLD. Sitting in bed with clenched fist. Pain

A

Levines sign = clenched fist

EKG which can show ST elevation

49
Q

COPD case study is for

A

our discharge assignment

Hospital Med (4 decks)

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