Extension for Community Healthcare Outcomes-Care Transitions: Enhancing Geriatric Care Transitions Through a...

Area of Science:

• Healthcare delivery innovation
• Interprofessional communication strategies
• Patient safety in care transitions

Background:

• Older adults face high-risk care transitions when discharged to postacute care facilities.
• Effective communication between hospital and postacute care providers is crucial for patient safety.
• Current models often lack robust interdisciplinary interaction during care transitions.

Purpose of the Study:

• To evaluate a novel videoconference intervention connecting hospital-based interdisciplinary teams with postacute care clinicians.
• To determine if this videoconference improves interprofessional communication and reduces medication errors.
• To assess the impact on care transitions for patients moving from hospital to postacute settings.

Main Methods:

• Prospective cohort study involving one tertiary care medical center and eight postacute care sites.
• Weekly videoconferences discussed patients discharged to postacute care, involving hospitalists, geriatricians, pharmacists, social workers, and trainees.
• Data collected included patient demographics, postacute provider satisfaction, and medication errors.

Main Results:

• Over two years, 907 patients were discussed via videoconference, primarily with skilled nursing facilities.
• Postacute care providers reported enhanced communication and improved access to hospital staff and information.
• Preliminary analysis identified pharmacy discrepancies, with 16% involving medication omissions.

Conclusions:

• The videoconference intervention (Extension for Community Healthcare Outcomes-Care Transitions - ECHO-CT) facilitates vital interdisciplinary communication.
• Preliminary findings suggest ECHO-CT may improve care transition processes between hospital and postacute care settings.
• This approach addresses communication gaps for older adults with complex needs transitioning between care levels.