Get the free Prioritized Post-Discharge Telephonic Outreach Reduces

Managerial prioritized PostDischarge Telephonic Outreach Reduces Hospital Readmissions for Select High-rise Patients L. Doug Melton, PhD, MPH; Charles Foreman, MD; Eileen Scott, RN; Matthew McGinnis,

How to fill out prioritized post-discharge telephonic outreach

How to fill out prioritized post-discharge telephonic outreach:

1. Start by gathering the necessary information about the patient's discharge. This includes their name, contact information, discharge date, and reason for hospitalization.
2. Prioritize your outreach based on the severity and complexity of the patient's condition. Allocate more resources and attention to those with higher risk and need for follow-up care.
3. Prepare a script or a set of talking points to ensure consistency and accuracy during the outreach call. This can include questions about the patient's overall well-being, medication adherence, follow-up appointments, and any concerns or questions they may have.
4. Conduct the telephonic outreach in a timely manner, preferably within 24-48 hours after discharge. This ensures that the patient receives the necessary support and guidance during their transition from hospital to home.
5. Be empathetic and supportive during the call, actively listening to the patient's needs and concerns. Provide clear instructions and educate them about their condition, medications, and potential warning signs to look out for.
6. Document the details of the outreach call, including any actions taken or recommendations provided. This will help in tracking the patient's progress and sharing relevant information with other healthcare providers involved in their care.
7. Follow up with any necessary referrals or additional interventions, ensuring that the patient receives the appropriate care and services they need.
8. Communicate with the patient's healthcare team, including primary care providers, specialists, and caregivers, to ensure seamless care coordination and exchange of information.

Who needs prioritized post-discharge telephonic outreach:

1. Patients with complex medical conditions that require additional support and monitoring after discharge.
2. Individuals who are at a higher risk of readmission or complications due to factors such as age, comorbidities, or lack of social support.
3. Patients who have undergone certain procedures or surgeries that require close follow-up care.
4. Those with a history of medication non-adherence or difficulty managing their health conditions.
5. Individuals who experienced significant changes in their treatment plan, medications, or lifestyle due to their hospitalization.
6. Patients with limited health literacy or language barriers, requiring extra assistance and education.
7. Individuals with mental health issues or social determinants of health that may affect their post-discharge care.

In conclusion, prioritized post-discharge telephonic outreach involves systematically conducting follow-up calls with patients after their hospital discharge. This process aims to provide support, monitor their progress, ensure proper care coordination, and reduce the risk of readmission or complications. It is particularly important for patients with complex conditions or higher risk factors.

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