Discharge Quiz: Patient Planning Questions and Flashcards

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Questions and Answers

What is the primary goal of discharge planning?

To ensure a smooth transition of patients from a health organization to their next destination

When should discharge planning with coordination of services ideally begin?

At the time of patient admission to the hospital

Which of the following disorders would NOT typically be treated in a psychiatric hospital?

Cancer

In discharge planning, what is the purpose of determining the appropriate post-hospital destination for a patient?

To facilitate the patient's continuing care after leaving the health care agency Signup and view all the answers

What does a transition coach typically help patients with in the context of discharge planning?

Navigating through post-discharge healthcare and support services 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?

Rural general hospital 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?

Developing the discharge care plan during in-hospital assessment Signup and view all the answers

What is the focus of the High-intensity Care Team in the GRACE Team Care Model?

Supporting the primary care physician Signup and view all the answers

Which of the following is a key component of patient participation in the model discussed?

Communication between nursing staff and the patient Signup and view all the answers

What is the objective of restorative care as mentioned in the text?

Enhancing quality of life by promoting independence and self-care Signup and view all the answers

Which professionals head the High-intensity Care Team described in the text?

Nurse practitioner and social worker Signup and view all the answers

What is the focus of postdischarge follow-up as part of the model discussed?

Helping patients manage their health conditions after discharge Signup and view all the answers

What factors does a case manager or social worker usually consider when selecting a setting for a patient?

Patient's health care needs, self-care capacity, insurance, and place of residence 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?

Nurses, therapists, health care providers, and dietitians 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?

Coleman’s “Care Transitions Program” (2006) Signup and view all the answers

What are the four pillars on which Coleman’s “Care Transitions Program” (2006) is based?

Medication self-management, patient-centered record, follow-up, indicators of worsening medical condition Signup and view all the answers

Which model emphasizes comprehensive discharge planning and follow-up for older adults who are chronically ill?

Naylor’s “Transitional Care Model” (2009) Signup and view all the answers

What does Naylor’s “Transitional Care Model” (2009) emphasize for older adults who are chronically ill?

Comprehensive discharge planning and follow-up 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.

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