Discharge and Transitions
by Michael Radzienda, MD
Treatment failures can be linked to poor discharge planning for a host of diagnoses. For comprehensive strategies that address improving transitions in care, refer to the BOOSTing Care Transitions Resource Room.
For DFI patients, the care transition from hospital to home or the next level of care can be a failure mode. Understanding the resources available to your patients after their hospitalization is key to ensuring seamless care. Depending on your patients’ socioeconomic status, health care benefits, health literacy, and overall performance status, successful execution of a comprehensive discharge plan may mean the difference between limb loss or limb salvage. The figure below illustrates potential failure modes for DFI patients after hospitalization and potential solutions to enhance outcomes.
Failure Mode DFI Outcome Strategy
Hyperglycemia |
Failure to heal
Extension of disease
Amputation |
- Diabetic education.
- Diabetic clinic follow-up.
- Simplify regimen
- Achieve glycemic control prior to DC.
- Provide diabetic care supplies.
|
Inadequate wound care |
Failure to heal
Extension of disease
Amputation |
- Patient/family education.
- Home care visits.
- Wound clinic appointment.
- Appropriate foot wear/orthotics.
- Weight-bearing modification.
- PT/OT evaluation.
|
Medication compliance |
Failure to heal
Extension of disease
Amputation |
- Prescribe affordable, generic, and once-daily antibiotics.
- Preauthorize antibiotics with insurance plan.
- PICC line maintenance.
- Postdischarge pharmacist call.
- Home health care services.
- Clear discharge medication list.
|
Consultant reconciliation |
Loss of continuity
Failure to heal |
- Follow up appointments made predischarge.
- Discharge plan sent to/discussed with all outpatient clinicians involved in care (not just PMD).
|
Health literacy |
Failure to heal
Extension of disease
Amputation
ADE |
- Use predischarge day as trial run for patient to demonstrate wound care abilities.
- Painstakingly discuss tenets of glycemic control, frequent skin inspection, and limb protection strategies with patient predischarge.
- Explicit instructions on what to look for and who to call at (at fourth-grade reading level and in patient’s first language).
- Provide patient with your card and instructions for follow-up appointments.
|
Download a larger version of the Diabetic Foot Infection Failure Modes/Outcomes/Strategies Chart.
SHM Hospital Medicine Hospitalist Quality Improvement Project Patient Safety Clinical Tool Information QI Tools Protocols Hospital Quality Patient Safety HQPS Primer QI Field Guide Hospital Quality Concepts |
|
|
