The creation of stronger care transition plans presents an opportunity for providers to see significant cost savings; inadequate care coordination cost hospitals an estimated $25 to $45 billion through complications and avoidable readmissions, according to the Robert Wood Johnson Foundation. The success of care transition depends a number of factors, however. As Chaisse Coulombe, VP of clinical quality at the American Hospital Association’s Health Research and Educational Trust (HRET), points out:
The complexity of the patient’s medical condition, socioeconomic circumstance and hospital processes-such as hand offs, medication reconciliation and patient education-contribute to complications in care transitions.
By accounting for these obstacles with a transition plan that includes family involvement whenever possible, providers can prevent avoidable readmissions. Coulombe adds:
A robust discharge plan, [including] significant involvement from other family members, is critical to returning the patient to his pre-hospitalization status.
Maureen Dailey, a senior policy advisor for the American Nurses Association agrees:
We need to make sure patients, families and caregivers are well prepared to effectively provide self-care upon discharge so that avoidable readmissions can be reduced. When a patient transitions, better information about self-care and medications from one setting to another is key not only from hospital to home, but to nursing home and long-term care hospitals.