CMSA Today - Issue 6, 2011 - (Page 8)

Canadian Perspective Canadian Perspective: A Systems Level Approach to Safe and Effective BY C. BELL, I. DHALLA, K. GROOTVELD, L. JEFFS, J. MCLEOD, and J. PARK St. Michael’s Hospital, Toronto, Canada Care P oorly executed care transitions can result in medication errors, delays in care, and avoidable re-admissions. For example, patients’ perceptions of their readiness for discharge and being inadequately informed were associated with difficulties with post discharge coping and the reoccurrence of readmission within the first three weeks (Mistiaen et al., 1997; Weiss et al., 2007). Interestingly, the need for safe and effective discharge planning was recognized in 1885 by Sir Thomas Locke who stated: “There is a need for someone at the hospital to direct the patient, to represent the patient and his interests…someone instructed as to all existing means of preventing and treating illness. He should help to make those who can become self-reliant or obtain help for those who need it or else medical care may fail of its good purpose.” In Canada, our accreditation body, Accreditation Canada, has required organizational practices (ROPs) specific to care transitions that include enhancing 1) information exchange and 2) medication reconciliation. Underpinning both ROPs is effective communication within transition points such as shift changes, end of service, and patient movement to other health services or communitybased providers (Accreditation Canada, 2010). Communication during care transitions includes multiple interactions and transfer of information within the organization, between staff and service providers, with the patient and family, and sending information to other services outside the organization. In addition, to ensure safer and more effective care transitions, primary care providers (family physicians) need timely notification of their patients’ hospital admissions, progress, and discharges (College of Family Physicians of Canada, 2003). Cognizant of the need to enhance care transitions, one organization has put in place a series of strategies and are conducting research which is outlined in this article. CARE TRANSITIONS STRATEGIES IMPLEMENTED AT ST. MICHAEL’S Care transitions refer to the movement patients make between health care practitioners and settings as their condition and care needs change during the course of a chronic or acute illness (Coleman, & Boult, 2003). The nature of the transition, transition conditions and therapeutic practices determines whether the outcome is positive or negative. Clients in transition tend to be more vulnerable to risks that may in turn affect their health (Meleis et al, 2000). A key mitigating strategy to minimize patient risk and negative outcomes is ensuring effective discharge planning with patients and their family (Weiss 8 CMSA TODAY Issue 6 • 2011

Table of Contents for the Digital Edition of CMSA Today - Issue 6, 2011

PRESIDENT’S LETTER CASE MANAGEMENT WITHOUT BORDERS: Promoting a Global View and a Universal Understanding
Canadian Perspective A Systems Level Approach to Safe and Effective Care
South African Perspective Hospital to Home – Comparative View of Transitions of Care
Cuban Perspective From Cuba to Milwaukee: Community-Oriented Health Care
VIEW FROM CAPITOL HILL PPC’s Busy Schedule Equates to Changes on the Health Care Front
ETHICS CASEBOOK Advocacy in Case Management: What Are the Limits?
MENTORING MATTERS Improving the Mentorship Role through Feedback This Is a Marathon – Not a Sprint
CASE MANAGEMENT AND THE LAW Deploying Case Management Programs to Reduce Legal Risks

CMSA Today - Issue 6, 2011