Hospitalized patients often experience a multitude of feelings—anxiety, fatigue and fear, not to mention possible pain. For those who require further treatment or recovery at post-acute facilities, a poor transition can heighten these feelings, adding stress to an already difficult situation.
Historically, post-acute patient placement has been a manual, somewhat impersonal process. Although case managers or discharge planners usually give the patient a list of possible post-acute facilities to consider, they commonly leave research and decision-making entirely up to the patient and his or her family. Additionally, when it comes time to transfer out of the hospital, the patient's medical record might—quite literally—travel on his or her lap to the receiving facility. Sharing medical records and discharge activities in such a disjointed, unconnected, way can lead to medication or medical errors, gaps in care and even unfavorable outcomes.
Discharges like these don't afford much opportunity for high-touch care, which most patients need during transition periods. Moreover, these types of discharges don't guarantee patients will transfer to a facility that is prepared to receive them or that can effectively meet their clinical or personal needs. If individuals are inappropriately placed, it can affect their overall satisfaction, as well as their clinical outcomes and readmission risk.