Patient dangers persist post-discharge

In the ongoing struggle to prevent patient harms and preventable readmissions, many providers overlook one of the most dangerous legs of the process: the discharge and post-discharge process.

'Poor transitional care is a huge, huge issue for everybody, but especially for older people with complex needs," Alicia Arbaje, an assistant professor at the Johns Hopkins School of Medicine in Baltimore, told Kaiser Health News. "The most risky transition is from hospital to home with the additional need for home care services, and that's the one we know the least about."

Nearly every step of the process features potential pitfalls. At hospitals, a minority of patients say they understood instructions about post-discharge self-care, while more than 1 in 3 nursing homes don't adequately assess patient needs or properly plan for their care. 

Indeed, between January 2010 and July 2015, more than 3,000 home health agencies inadequately monitored medications for new patients, according to the publication's analysis of inspection records. In many cases, nurses did not flag drug combinations with potential side effects such as kidney damage, bleeding or abnormal heart rhythms. Part of the problem, according to the analysis, is the broad range of post-hospitalization care patients may use, from pharmacies to specialists to urgent care clinics, and the typical lack of coordination and communication among them.

Federal efforts to improve care coordination have largely passed this sector by, according to the article; of $30 billion Congress appropriated to fund the conversion to electronic medical records, none of it went to nursing homes, providers who do at-home work or rehabilitation centers. The result, said Robert Wachter, a professor at the University of California, San Francisco, is a system struggling with lack of connection at several levels.

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