New Year Resolutions: Improving Transitions of Care

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Posted on Behalf of Sara Wildes, VP of Business Development

Below are a handful of startling statistics and studies reinforcing, as an industry, we need to continue to strive to improve proactive communication and transitions of care hand-offs, to improve patient outcomes, minimize patient re-admissions, and curtail the rising administrative cost of supporting care delivery. A simple solution promoting secure data access, proactive notifications leveraging existing infrastructure, and data exchange can play a powerful role in bridging the communication gap between hospitals and in or out of network providers.

  • 20% of patients experience an adverse event less than one month from discharge. ¾ of those events could have been avoided.

A famous study found that nearly 1/5 of patients have adverse events within 3 weeks of discharge, 75% of which could have been mitigated. Imagine that. If an organization is discharging 94,000 patients every year, without early intervention for post-acute follow-up, 18,800 of those patients are at risk for an adverse event, and approximately 14,000 of those events could be prevented or ameliorated.

Late hand-off communication or ineffective hand-off communication is considered a significant patient safety issue in health care. An estimated 4/5ths of medical errors involve delayed communication or miscommunication between caregivers during the discharge of patients. The hand-off process involves hospitals, those stakeholders transmitting patient information and transitioning the care of a patient to the next clinician (i.e. PCP, Home Health, or Long Term Care agency), and then those caregivers who accept the patient information and care of that patient. In addition to causing patient harm, defective hand-offs can lead to delays in treatment, inappropriate treatment, patient readmissions, and potentially an increased length of stay in the hospital.

3,489 non-federal acute care hospitals routinely electronically notify a patient’s PCP when he or she is admitted into the hospital’s Emergency Room, but that leaves 2,326 hospitals who are not routinely electronically notify the patient’s Primary Care Provider. If the Primary Care Provider is outside the Hospital Health System, “out of network, only 1/3 of hospitals (1,744) notify the PCP.  This lack of communication leads to poor care continuity.

Within the current healthcare landscape, which includes growing specialization and fragmented provider communications, re-admission of high-risk patients continues to be too prevalent.  Primary care providers, the best defenders against readmission, are not notified of critical patient events or discharge, or there are delays in or incomplete communication, leading to poor patient outcomes and escalating costs.

Simple, cost effective technology promoting secure data access, proactive notifications, and data exchange can help address these communication challenges experienced during care hand-offs. Clinical expense can be reduced, and better patient care is preserved using pre- and post-discharge communication and follow-up that supports the transition of care process.

By | 2018-01-09T11:25:38+00:00 January 3rd, 2018|Care Coordination, Healthcare IT|