Podcast
Questions and Answers
What is the primary goal of discharge planning?
What is the primary goal of discharge planning?
When should discharge planning with coordination of services ideally begin?
When should discharge planning with coordination of services ideally begin?
Which of the following disorders would NOT typically be treated in a psychiatric hospital?
Which of the following disorders would NOT typically be treated in a psychiatric hospital?
In discharge planning, what is the purpose of determining the appropriate post-hospital destination for a patient?
In discharge planning, what is the purpose of determining the appropriate post-hospital destination for a patient?
Signup and view all the answers
What does a transition coach typically help patients with in the context of discharge planning?
What does a transition coach typically help patients with in the context of discharge planning?
Signup and view all the answers
Which term describes a small hospital specifically trained and staffed to provide healthcare services in remote and rural areas?
Which term describes a small hospital specifically trained and staffed to provide healthcare services in remote and rural areas?
Signup and view all the answers
What is the main role of the transitional care nurse/advanced practice nurse/gerontological nurse in the model described?
What is the main role of the transitional care nurse/advanced practice nurse/gerontological nurse in the model described?
Signup and view all the answers
What is the focus of the High-intensity Care Team in the GRACE Team Care Model?
What is the focus of the High-intensity Care Team in the GRACE Team Care Model?
Signup and view all the answers
Which of the following is a key component of patient participation in the model discussed?
Which of the following is a key component of patient participation in the model discussed?
Signup and view all the answers
What is the objective of restorative care as mentioned in the text?
What is the objective of restorative care as mentioned in the text?
Signup and view all the answers
Which professionals head the High-intensity Care Team described in the text?
Which professionals head the High-intensity Care Team described in the text?
Signup and view all the answers
What is the focus of postdischarge follow-up as part of the model discussed?
What is the focus of postdischarge follow-up as part of the model discussed?
Signup and view all the answers
What factors does a case manager or social worker usually consider when selecting a setting for a patient?
What factors does a case manager or social worker usually consider when selecting a setting for a patient?
Signup and view all the answers
Who usually identifies a patient's needs for a smooth and safe transition from the acute care hospital to their discharge destination?
Who usually identifies a patient's needs for a smooth and safe transition from the acute care hospital to their discharge destination?
Signup and view all the answers
Which model emphasizes the role of a transition coach in facilitating the discharge of a patient to home or a rehabilitation center?
Which model emphasizes the role of a transition coach in facilitating the discharge of a patient to home or a rehabilitation center?
Signup and view all the answers
What are the four pillars on which Coleman’s “Care Transitions Program” (2006) is based?
What are the four pillars on which Coleman’s “Care Transitions Program” (2006) is based?
Signup and view all the answers
Which model emphasizes comprehensive discharge planning and follow-up for older adults who are chronically ill?
Which model emphasizes comprehensive discharge planning and follow-up for older adults who are chronically ill?
Signup and view all the answers
What does Naylor’s “Transitional Care Model” (2009) emphasize for older adults who are chronically ill?
What does Naylor’s “Transitional Care Model” (2009) emphasize for older adults who are chronically ill?
Signup and view all the answers
Study Notes
Models of Care
- The transitional care model consists of six key components: in-hospital assessment, discharge preparation, patient participation, continuity of care, predischarge assessment, and postdischarge follow-up.
- The High-Intensity Care Team (GRACE Team Care Model) is led by a nurse practitioner and a social worker, supporting primary care physicians and addressing patients' health conditions.
Restorative Care
- Restorative care aims to help individuals regain maximal functional status and enhance quality of life through promotion of independence and self-care.
- Patients often require restorative care after early discharge from hospitals.
Types of Hospitals
- Mental health facilities, also known as psychiatric hospitals, specialize in treating severe mental disorders.
- Rural hospitals are small hospitals trained and staffed to provide healthcare services in remote and rural areas.
Discharge Planning
- Discharge planning is a coordinated, interprofessional process that develops a plan for continuing care after a patient leaves a healthcare agency.
- Discharge planning involves determining the appropriate post-hospital destination, identifying a patient's needs, and meeting those needs while the patient is still hospitalized.
- Discharge planning models include Coleman's "Care Transitions Program" and Naylor's "Transitional Care Model".
Discharge Planning Models
- Coleman's "Care Transitions Program" (2006) emphasizes the role of a transition coach and is based on four pillars: medication self-management, patient-centered record, follow-up, and indicators of worsening medical condition.
- Naylor's "Transitional Care Model" (2009) focuses on comprehensive discharge planning and follow-up for older adults who are chronically ill.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Test your knowledge on patient discharge planning, a crucial process which involves identifying a patient's needs for a smooth transition from a healthcare facility to their discharge destination. Learn about the roles of case managers, social workers, nurses, therapists, and healthcare providers in this process.