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How to use or fill out DOWNTIME Discharge Plan -- transitional care hospital - virginia
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Click ‘Get Form’ to open it in the editor.
Begin by entering the date and time at the top of the form. This is essential for tracking discharge details.
In Section I, select the discharge destination from the provided options. If applicable, specify any other destination not listed.
Fill in the anticipated discharge date and provide a list of available facilities if required. Ensure to include contact information for the selected facility.
Proceed to Section II and indicate the mode of transport along with the anticipated arrival time and transport contact phone number.
For Sections III to V, enter details regarding home health/hospice services, home infusion companies, and medical equipment companies as needed, including start dates and contact information.
In Section VI, list community resources that may assist post-discharge. Include agency names and contact persons.
Finally, ensure that Section VII is completed with the name/relationship of the person approving discharge along with their signature and date.
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Transitional care management ensures patients who have a high-risk medical condition will receive the care they need immediately after discharge from a hospital or other facility.
What is a transitional care model?
Transitional care includes a range of time-limited services designed to ensure health care continuity and prevent poor outcomes among at-risk populations as they move from one level of care to another, among multiple health care team members, and across settings, such as hospitals to homes.
What is the transitional care discharge model?
BEST PRACTICE: The Transitional Care Model (TCM): Hospital Discharge Screening Criteria for High Risk Older Adults identifies 10 screening criteria developed and modified based on the results of completed randomized clinical trials of older adults with common medical and surgical diagnosis related groups (DRGs) (e.g.,
What is the transition of care theory?
The TCM emphasises a multidisciplinary approach to patient care, led by the transitional care nurse who remains in contact with other providers including physicians, nurses, social workers, discharge planners and pharmacists. A reduction in the 90-day readmission rate of between 13% and 48% has been reported.
What is the TCM model?
Transitional Care Model (TCM) TCM focuses on decreasing hospitalizations and readmissions for patients. TCM prepares patients and caregivers to manage changes in health associated with MCCs. TCM has nine key components that help create a successful transition: Screening.
It is a transition point along the patients health journey. Reduce hospital length of stay and unplanned readmission to hospital. Discharge planning includes identifying any services, equipment or follow-up that may be needed to safely transition the patient home or elsewhere.
Related links
UNIVERSITY OF VIRGINIA HEALTH SYSTEM
DOWNTIME DIschargE PlaN -- TraNsITIONal carE hOsPITal. UNIVERSITY OF VIRGINIA HEALTH SYSTEM. 0400002. FORM # 100478 CAT: 4-dIsCHARgE dOCuMENTs (REV. 02/2013)
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