Transition of Care Home Visit Tool
Transition of Care Home Visit tool, used with permission from Department of Veterans Affairs.
Transition of Care Home Visit tool, used with permission from Department of Veterans Affairs.
Conveying accurate patient information during patient transfer or hand-off is essential to ensuring safe, high-quality care. However, studies have shown that more than two-thirds of adverse patient events are related to communication errors.
The AHCP is designed to clearly present the information needed by patients to prepare them for the days between discharge and the first visit with their ambulatory care physician.
This toolkit is designed to help hospitals implement the Stanford University Chronic Disease Self-Management Program (CDSMP), an evidence-based prevention and health promotion program that addresses common issues faced by people with chronic conditions.
The core concept of the reconceptualized model of certified practice - the AACN Synergy Model for Patient Care - is that the needs or characteristics of patients and families influence and drive the characteristics or competencies of nurses. Synergy results when the needs and characteristics of a patient, clinical unit or system are matched with a nurse's competencies.
This resource is a modified version of the LACE tool, focused on nursing; and incorporating additional checklists for more comprehensive discharge planning and assessment.
The LACE tool is one of meany designed to assess risk of patient readmission or death upon discharge.
The 8P Screening Tool is designed to identify a patient's risk for adverse events after discharge.
The National Database of Nursing Quality Indicators® (NDNQI®) delivers evidence to support the importance of nurse sensitive measures in overall patient experience strategy.
The CALNOC registry captures and benchmarks unit data, structural measures, process measures, and outcome measures.