Transitioning Care

Question 1

what is the discharge portion of this lecture

Answer 1

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

Question 2

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

Answer 2

Hospital admission

Question 3

Goals and risk of emergency department

Answer 3

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

Question 4

What is the principal diagnosis vs problem list

Answer 4

main diagnosis and problems that they have

Question 5

What info is given to ED

Answer 5

Principal diagnosis
diagnosis list
cognitive status
test results

Question 6

what additional info may be requested for a transfer of care

Answer 6

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

Question 7

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

Answer 7

Direct admissions

not typically done (as it is complex)

Question 8

Direct admissions pros/cons

Answer 8

saves hours
saves overcrowding

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

Question 9

What are some recommendations for direct admissions

Answer 9

stable
admitting diagnose is clear
evaluated the DAY of

Question 10

What is the clear communication between the PCP and the hospitalist

Answer 10

rationale
diagnosis
labs

Question 11

Prior to transfer
during transfer
after transfer

problems

Answer 11

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

Question 12

What is the complicated patient

Answer 12

skill nursing facility

very hard patients to treat

Question 13

Post form

Answer 13

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

basically what the patient wants

Question 14

What is the emergency department

Question 15

Do patients leave the ED immediately after being admitted?

Answer 15

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

Question 16

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

Answer 16

YES

Question 17

Outpatient VS Inpatient status is determined by

Answer 17

CMS and insurance

Question 18

___ midnight rule

Answer 18

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.

Question 19

Do we prefer inpatient or outpatient

Answer 19

inpatient for money

Question 20

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

Answer 20

Outpatient

stent placement is also outpatient

Question 21

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

Answer 21

Med/surge

lower critical patients

Question 22

What is a telemetry unit

Answer 22

more frequent monitoring every 4 hours

have cardio techs

Question 23

what is an intermediate care unit

Answer 23

treated like intensive care, but NO critical care MEDS

Question 24

What is intensive care units?

Answer 24

Broken down based on organ system

may transfer from one unit to another

Question 25

Who needs telemetry

Answer 25

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

Question 26

How often should telemetry patients be reevaluated?

Answer 26

DAILY

Question 27

What is the handoff process?

Answer 27

Fluid dynamic exchange, discharge. Subject to distraction and interruptions.

Question 28

What are types of intrahospital handoffs?

Answer 28

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.

Question 29

What are the core components of handoffs?

Answer 29

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

Question 30

What are the core steps of the handoff process

Answer 30

Pre-handoff arrival Dialogue Post-handoff

Question 31

What are the two standardized handoffs

Answer 31

IPASS and SBAR

Question 32

IPASS

Answer 32

Introduction Patient identification Assessment Situation Safety concerns

Question 33

SBAR

Answer 33

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

Question 34

What is hospital discharge

Answer 34

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)

Question 35

What are some unsucessful discharge transition?

Answer 35

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

Question 36

What are key elements of discharge care coordination

Answer 36

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

Question 37

Choosing a discharge destination

Answer 37

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

Question 38

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

Answer 38

only once every 30 days!

Question 39

For scheduling f/o appointments what is important

Answer 39

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

Question 40

When should a patient f/o?

Answer 40

Severity of illness Comorbidites

Question 41

When should patients f/o with PCP after discharge?

Answer 41

One week, sometimes two sometimes 48 hours if really concerned, but not realistic

Question 42

What should be given after discharge?

Answer 42

RED FLAGS

Question 43

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

Answer 43

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!

Question 44

What is some patient engagement and education?

Answer 44

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

Question 45

What should discharge include

Answer 45

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

Question 46

What is the handoff discharge summary

Answer 46

needs to be detailed to make sure PCP knows what happens needs to be done by 30 days, but on you after 15 days

Question 47

Components of discharge

Answer 47

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

Question 48

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

Answer 48

Levines sign = clenched fist EKG which can show ST elevation

Question 49

COPD case study is for

Answer 49

our discharge assignment