Evidence Summary and Recommendations for Improved Communication during Care Transitions.

Area of Science:

• Healthcare communication strategies
• Patient transition management
• Veterans Affairs healthcare system

Background:

• Effective communication is vital for patients, especially Servicemembers and Veterans, navigating complex medical issues and multiple care levels.
• Transitions between care levels require detailed, individualized information for optimal clinical outcomes and patient satisfaction.
• Complex cases often involve communication among multiple family members.

Observation:

• The Veterans Affairs (VA) Polytrauma System of Care manages complex cases requiring seamless transitions.
• An evidence-based review was conducted by the VA Office of Nursing Service Polytrauma Field Advisory Committee.
• A clinical panel of polytrauma nursing experts and direct care rehabilitation nurses was consulted.

Findings:

• The review identified key practice recommendations for facilitating patient care transitions.
• A standardized plan of care template was developed.
• Plans for dissemination and implementation of findings are outlined.

Implications:

• Standardized, direct communication is recommended for successful patient transitions within the VA system.
• Effective communication requires focus and an understanding of larger healthcare systems.
• Implementing these recommendations can enhance care coordination and patient outcomes.