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Care transitions

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  • Topic: Care transitions
  • Topic: Benchmarks and best practices
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Affordable Care Act Implementation: How Is it Affecting the Health Care Workforce?

April 7, 2011 | Story

As the first components of the new health care reform law begin to take shape, a new and very different world appears on the horizon for health care workers in many parts of the system.

Englewood Hospital & Medical Center

September 1, 2006 | Toolkit

Standardized forms were created by the hospital for patients admitted to the hospital from the emergency department (ED).

Discharge Nurse Position Description

June 4, 2008 | Toolkit

Staff at the University of Texas M.D. Anderson Cancer Center, Houston, Texas, began using an experienced nurse to support the clinical nurses by coordinating discharge activities, serving as a liaison to other team members and ensuring that all aspects of discharge are complete for patients and families.

Heart Failure Encounter Form

June 1, 2008 | Toolkit

An off-site, nurse-led heart failure clinic was created to help heart failure patients better control and self-manage their disease post-hospitalization.

Cardiology Admission Orders Physician's Order Sheet

June 4, 2008 | Toolkit

Staff combined information from three existing order sets into a single, comprehensive cardiology admission order set to reduce provider confusion and help the hospital reach regular compliance rates of 90 to 100% for evidence-based cardiac measures.

Patient Discharge Instruction Record

June 4, 2008 | Toolkit

Sinai-Grace Hospital in Detroit, Mich., developed a systemwide universal discharge instruction form, merging general discharge instructions with cardiac-specific discharge instructions for patients with acute myocardial infarction or heart failure.

Adherence to Discharge Guidelines for Late-Preterm Newborns

July 1, 2011 | Journal Article

Babies born between 34 to 36 weeks' gestation are being discharged early at stubbornly high rates in some regions and types of hospitals, despite mid-1990s care guidelines and insurance mandates to cover longer hospital stays.

Methodology Issues in Implementation Science

April 1, 2013 | Journal Article

Four case studies on recommendations to advance implementation science.

Edward Hospital

September 1, 2006 | Toolkit

Related websites Urgent Matters Web site In order to conduct individual patient follow-ups, a call back clerk phones discharged patients to inquire about the status of their medical conditions and their satisfaction with their providers. This inform ...

St. Joseph's Hosptial & Medical Center

September 1, 2006 | Toolkit

Related websites Urgent Matters Web site The hospital developed a comprehensive diversion reduction plan to improve efficiency of hospital discharges and identified a team of individuals to oversee implementation of the plan. The plan sets guideline ...

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