ModuleContentGuidelines-SeattleChildrensHospital.docVIP

COE4CCN: Transitions of Care Quality Measures Module Content Guidelines Transitions of care create situations where the care of the patient is handed off to a new set of healthcare providers or to patient self-care, in the case where the patient is going home after a hospitalization. An effective transition will support the likelihood of reducing the incidence of inappropriate care and potential medical complications in the next settings of care. This data collection abstraction tool collects data to evaluate the coordination of care when children are discharged from an inpatient hospitalization. It is limited to children less than 19 years of age. If focuses on 3 areas of transition care: transition from the ICU to floor care, patient instructions at the time of discharge, and communication with the post-discharge follow-up provider, that is, the existence and content of any printed transition report that is given to the patient at discharge, and the communication between the hospital provider at discharge and the patient’s PCP. The quality measures contained in this abstraction tool are shown in Table 1. Table 1: Transitions of Care Quality Measures TFC #6 Patient transition record Children/adolescents admitted to the hospital, should have documentation in the medical record of a transition record that contained the following: Admission and discharge diagnoses Medication list at discharge Pending test results Follow-up tests that need to be completed List of follow-up appointments 24/7 telephone contact number if problems arise Number to call for assistance getting needed appointments Immunizations given Admit and discharge dates THS #2 Follow-up provider contact Children/adolescents discharged from the hospital, should have documentation in their medical record that the receiving outpatient follow-up provider was contacted (phone/email/FAX) by a hospital provider within 48 hours of the patient’s discharge THS #3 ICU-Floor Transfer Hospitalized childr