Transitional Care: A Case Study

Motivating hospitals to ensure proper policy is followed can lead to a reduction on spending every year due to medical errors. Holding healthcare facilities responsible for

Evidence supports transitional care programs as a means of improving quality of patient care and reducing 30-day readmission rates. Multiple models exist and all center on common goals of early patient identification, disease-specific patient education, medication reconciliation and education, office follow-up and timely coordination of care and sharing of medical records penitent to patient’s case.

This model reimburses hospitals based on quality of care instead of the volume of patients. The quality of care is assessed by patient questionnaires and if hospitals are unsatisfactory penalties may be imposed (Edwoldt, 2012). The value-based system also affects Medicare and Medicaid. It was reported that Medicare readmissions within 30 days of discharge cost 17 billion dollars annually (Edwoldt, 2012). Due to the high costs of readmissions Medicare and Medicaid have implemented a Hospital Readmission Reduction program. A formula is utilized to evaluate readmission rates within 30 days of discharge for any medical reason related to their original admission such as heart failure and pneumonia. Upon review the hospital is potentially penalized. It is important that nurses strive to provide excellence in care despite their beliefs on the ACA. Nurses have the ability to provide a safe patient environment and reduce the risk of hospital associated infections by following hospital protocols such as hand washing.

According to Health Grades, 2009, total Direct cost of unsafe infection practice to Unit-ed State is $535 million while cost to patient safety events is 6.8 billion to federal Medicare pro-gram and also leads to 92,882 preventable deaths in USA. Top 250 hospitals of US have achieved patient safety excellence award, which has a potential to save 2 billion of federal money and 22,771 deaths from Medicare patients (Health Grades, 2009). Institute of medicine (IOM) has estimated that adverse drug reactions cost 1.5 million to the govt.which can be reduced with proper interventions (Classen, Jaser & Budnitz, 2010). Total cost due to medical errors is 29 bil-lion annually, which includes costs due to medical bills and due to loss of income and other dis-abilities. Seeing the severity of patient safety events, it is necessary for the hospitals to take proper steps towards patient safety. Each step towards patient safety saves hundreds of lives and thousands of dollars. Preventable medical errors affect the trust of patient on health care person-nel (Health Grade, 2009).

The hospital acquired urinary tract infection that Mrs. Zwick developed during her hospital stay is not covered by Medicare. Research of an article in Medical News Today states:

When the physicians order for the patient’s transition of care, either home or to a lower level of care, such as Rehab and Skilled Nursing Facilities, they look at certain criteria. Unfortunately there are times when I would notice patients return to the hospital causing a re-admission. Even if they say that the patient was handed of properly, teaching was done prior to discharge and

Medicare is trying to create incentives for hospitals to keep from making patients sicker, instead of healthier, during their inpatient stay. Hospital-acquired conditions (HACs) can lead to poor patient results

The purpose of the ANTT is to protect the patient and nurse from infection and to prevent the spread of pathogens. This can have a huge effect on the recovery rate of the patient. HCIA can mean a longer stay or readmission to hospital and in some cases lead to disability or death (Hart 2007). This information suggests that the ANTT is not being carried out correctly and Department of Health (2005) support this by stating that 9% of patients contract HCAI’s per year in UK hospitals.

The practice intervention that I will be evaluating was undertaken in a local authority statutory children in care team. Kieran was made subject to an interim care order (S.38 Children Act, 1989) shortly after birth, following concerns that his parents were not meeting his basic needs in terms of food, warmth and nurturing. The mother Sarah has three children from a previous relationship who have all been removed from her care. Paul is the putative father and Kieran is their first child together. My role in this case was to assess the parenting capacity of Paul alongside concurrent planning for the adoption of Kieran. Paul and Kieran and were placed in a parent and baby placement as part of the assessment, however at the point of my intervention Paul had left the placement, leaving Kieran with the foster carers. Whilst this intervention was the subject of TMA 02 in my early stages of practice placement, there were further developments in that Paul was found not to be the father of Kieran and the birth father was in fact Sarah’s previous partner Martin, who was the father to her previous three children. Martin then made an application for the care of Kieran and therefore I was required to undertake a parenting assessment of him also. I have selected this case again as it demonstrates my continuing development as a critical practitioner in ‘applying reflection and curiosity to practice’ (The Open University 2016 a p.92) as well as how critical appraisal of further specialist

The three systems whose factors greatly affect the efficient delivery of services are hospitals, long-term care facilities and mental/behavioral health services. Each of these are significantly impacted by diverse influences, affecting the direction and method for health care delivery. For hospitals, the three factors are vertical integration, horizontal integration and sources of power, or stakeholders (). Horizontal and vertical integration are both structure mechanisms, but are very different in nature and their impact on the hospital system. Horizontal integration allows facilities in different geographic areas and different financial status affiliate with one another through a larger organization for the purposes of offering similar services.

Because SSI rates for healthcare facilities are made public, patients are able to gain knowledge of how well their facility SSI prevention practices work. “It is moving fast and furiously because consumers are pleased with the progress that has been made in reducing central line infections,” says Linda Greene, MPS, RN, CIC, director, infection prevention, Rochester General Health System, Rochester, New York. The public now expects the same transparency for SSIs” (Patterson, P., 2011) .Facilities that participate in Medicare must report their SSI for certain procedures; the list of procedures to report continues to grow as patients’ demand for listed procedures grow. ” SSI data will be reported through the National Healthcare Safety Network (NHSN) managed by the Centers for Disease Control and Prevention (CDC), a secure, web-based surveillance system for reporting data on infections and other events. The data can then be used for analysis, facility comparisons, and quality improvement.” (Patterson, P., 2011) Hospitals will, and should, continuously search for new ways to increase their quality of care. Having a great overall rating for a low number of incidences of SSIs can only boost their ratings.

Every executive in the hospital should be concerned about patient safety. Adverse drug events (ADEs) are costly, both in human terms and money. The cost of each ADE is significant, according to The Leapfrog Group (2014), each “ADE adds more than $2,000 on average to the costs of hospitalization.” As CFO, I need to balance the cost of new technology with patient safety. As CFO, I would like to have some incentives to implement these costly CPOE systems; however, these incentives may not help Suburban hospital improve quality of care. Lee et al. (2012). Found that the CMS policy to decrease payments to providers based on in-hospital infection rates “had no measurable effect on infection rates in U.S. hospitals.”

Controlling spread of infection is the key for the individual or the health care provider and washing hands is the first step. Hand washing is the most single most important strategy for preventing infection transmission. HAIs are the most common complication of hospital care. However, recent studies suggest that implementing existing prevention practices can lead to up to a 70 percent reduction in certain HAIs. The financial benefit of using these prevention practices is estimated to be $25.0 billion to $31.5 billion in medical cost savings (Healthypeople.gov 2020).

The major barrier to implementation of improving MRSA management through MRSA decolonization strategies is economic in nature. Financial costs are associated with both MRSA screening and decolonization strategies (Nelson, Samore, Smith, Harbarth, & Rubin, 2010). As an APN, the author was trained to analyze healthcare policies and submit recommendations that could further improve patient healthcare outcomes. The author believes that the hospital business administrators will be alarmed once she submits the proposal for adding MRSA screening and decolonization guidelines to the hospital’s policy on SSI prevention. Typically, hospitals try to avoid spending money on things that they do not see immediate

IC.02.01.01: The hospital implements its infection prevention and control program, including surveillance, to minimize, reduce, or eliminate the risk of infection.