continuity of care after discharge.

One of the greatest ways to improve patient’s outcomes is to establish continuity of care after discharge. With shorter hospitals stays it is crucial that patients are not left alone and have professional supervision and health maintenance in outpatient and home settings. It seems to be a huge problem when patients get discharged from the hospital and do not get follow up care. Social workers and case managers solely responsibility is to ensure that patient’s have a smooth transition from acute hospital care to home based healthcare. Many hospitals and nursing homes collaborate with home care agencies and make sure that patients receive all necessary nursing care, physical and occupational therapy and assistance with ADLs if needed. That approach ensures that patient’s outcomes will only improve and reduce hospital admission and re-admission rates. According to the article, “ the 2010 Affordable Care Act launched in the United States included financial incentives for providers to continue making a positive contribution to patient outcomes beyond the day of discharge. For instance, Medicare reduces provider compensation if patients are readmitted within 30 days of discharge.” ( Health Management , 2017) It has been evident that socioeconomic factors, such as low-income, poor education, public housing increase the rates of hospital re-admission rates. Patients who live in those environments require more supervision and support in order to increase their positive health outcomes. Community health nurses, social workers are responsible to ensure that people who have these disadvantages receive quality healthcare, support and education to ensure that all their health needs are met.

Comment 2( Answer the teacher for my post, now I need to answer to him)

I agree that nurse staffing has been an issue. I recommend that you do some research regarding the California staffing levels and the outcomes of implementing that system. You may find that there is not a lot of information on the subject. Have you ever wondered why all stated did create mandatory staffing ratios? Food for thought. Thanks for your post

 

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