Transitional Care Reduces Readmissions

Post-acute care
As transitional care is increasingly used to reduce hospital readmissions, progressive care nurses can play an integral role in efforts to help patients achieve functional recovery faster in post-acute care, according to an article published in the journal Critical Care Nurse (CCN).  

The report, “Progressive Mobility as a Team Effort in Transitional Care,” discusses the importance of interdisciplinary team strategies for incorporating progressive mobility and functional independence into the daily routines of transitional care patients.

“With the increased focus on reducing readmissions, it has become imperative for all members of the interprofessional team to coordinate plans of care for each patient in transitional care,” says lead author Margaret Ecklund, RN, MS, CCRN, ACNP-BC, a lead advanced practice nurse for the complex care transitional programme in the Rochester General Health System, New York.

Patients recently discharged from the hospital may move to a transitional care facility. Their diverse conditions may include congestive heart failure, chronic obstructive pulmonary disease, pneumonia and postoperative debility, all requiring skilled nursing and rehabilitation.

Mobility is a core component of patients’ care plans and a crucial element of their being discharged home, according to the CNN article. It is also a key indicator for insurance coverage for post-acute stay at a transitional care facility.

“Mobility gets woven into the fabric of daily activity, rounds and plan of care,” Ecklund notes. “In a culture of progressive mobility, team members hold one another accountable for their roles in safe mobility.”

Jill W. Bloss, a physical therapist for Rochester's complex care transitional programme, co-authored the journal article, which adds to the body of knowledge related to progressive care nursing.

The American Association of Critical-Care Nurses (AACN) introduced the term progressive care more than a decade ago to describe the care needs of acutely ill patients who are moderately stable with a high risk of instability. In recent years, the association published a clinical guide of essentials for progressive care nursing and the core curriculum for this emerging practice and launched PCCN certification — AACN Certification Corporation’s fastest-growing credential.

Progressive care nurses also may practice in long-term acute care hospitals, where patients — especially those who are ventilator-dependent — may receive care.

As AACN’s bimonthly clinical practice journal for high acuity, progressive and critical care nurses, CCN is a trusted source for information related to the bedside care of critically and acutely ill patients.

Source: American Association of Critical-Care Nurses
Image credit: U.S. Department of Labor

References:

Ecklund ME, Bloss JW (2015) Progressive Mobility As a Team Effort in Transitional Care. Crit Care Nurse June 2015 doi: 10.4037/ccn2015622

Published on : Thu, 4 Jun 2015


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healthmanagement, care transitions, transitional care, progressive care, nurses, readmissions As transitional care is increasingly used to reduce hospital readmissions, progressive care nurses can play an integral role in efforts to help patients achieve functional recovery faster in post-acute care.

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