Monday, October 15, 2012

Keeping Patients Healthy After Hospital Discharge

Most of us don’t want a return trip to the hospital—we want a one-way ticket out.

But sometimes patients leave the hospital without a clear understanding of their diagnosis, changes to their medications and diet, follow-up appointments with providers, and how to care for themselves post-hospitalization. Studies show that if patients do not see their primary care physicians within seven days of hospital discharge, there is a strong chance they will be back in the emergency department or readmitted.

Traditional hospital philosophy is to rehabilitate patients during their stay, but with Care Managers, Meritus Medical Center is helping patients maintain their health once they leave the hospital.

This week, Oct. 14-20, is National Case Management Week. To celebrate, we’d like to highlight the work of Meritus Health’s care managers.

Care managers in the emergency department (ED). Our ED care managers are registered nurses who educate patients on preventing and managing diseases. They help patients identify primary care physicians and community resources, arrange outpatient services and make follow-up physician appointments for patients discharged from the ED.

Patient education. Throughout the hospital stay, patients and their families receive education on the patient’s diagnosis and treatment plan. Care managers ask specific questions, checking for patients’ understanding of their conditions and comprehension of steps needed once they leave the hospital.

Discharge planning begins at admission! Our social workers and care managers work with physicians, including hospitalists (hospital-based doctors), to coordinate follow-up tests, outpatient services, doctor appointments, medications, transportation and home nursing needs. So, there’s less waiting around on discharge day—and you have what you need for a successful return home.

Hello, it’s your care manager calling. Care managers from the discharge advocacy center act as a safety net and continue to check the patients’ health once they leave the hospital. They call patients to make sure discharge instructions are understood and being followed, check for any changes in conditions, explain post-discharge test results and make physician follow-up appointments.

It’s care management to the rescue, but as a patient, you own a part of post-hospitalization health. To prevent illnesses from reoccurring, follow these tips:
  • Know the warning signs of changes in your condition. 
  • Fill prescriptions right away. 
  • Make and keep follow-up appointments. 
  • Lean on family and friends for help around the house. 
  • Use recovery time to research and better understand your condition. 
By: Anne Gill

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