A Description And Defense Of The Change

1346 Words Apr 15th, 2015 6 Pages
3. A description and defense of the change in policy, procedure or program
Description: Detailed Process mapping for coordination of care
Developing strategies to achieve ideal transition in care can be described as better “discharge planning, complete communication of information, availability, timeliness, clarity and organization of information, medication safety, educating patients to promote self-management, advance care planning, coordinating care among team members, monitoring and managing symptoms after discharge and follow up” (Kripalani et al., 2014)

The Proposed program focuses on the one critical process of coordination of care – timely communication for timely follow-up plan and follow-through after discharge by designated disciplines and ICT.

There are several arms and process flows depending on the discipline and resources identified by process mapping in one acute- hospital in the community.

First I identified several key disciplines that play an important roles for this coordination of care during transition occurs. Inputs in terms of logic model are 1.ICT/EHR, 2.Hospitalist (physician works at hospital), 3. Nursing Staff/Care coordinator at hospital, 4. Nursing Staff/Care coordinator at primary care physician’s office.
Arm 1. Who: ICT/EHR
When: discharge order placed
Where: in EHR system at the acute-care hospital
What: Integrating decision support system for physician, data collection& report system within existing EHR and order system.
How:
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