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Wednesday, December 17, 2008 9:00 AM
Navigating Health Care: Care Transitions - What You Need to Know

Rand: Whether you’re changing doctors, moving from a rehab facility to a nursing home, or being discharged from a hospital, a transition in health care comes with some risk. Patients - often those with complex medical needs - can face potential problems, mostly resulting in miscommunications between health care providers, clinicians, patients and their families. AHRQ Director Dr. Carolyn Clancy is with us to talk about how to navigate these health care transitions.

Rand: Dr. Clancy, for consumers who may not be familiar with phrases like "care transitions" or "medical handoffs" as some clinicians call them, what do these terms mean?

Dr. Clancy: "Handoffs" is an informal term for a whole series of activities that needs to take place when an individual transitions in care from one setting to another, from one clinician to another. For example, this could happen when a patient moves from one part of the hospital to another, when the patient is discharged from the hospital, when a patient goes from a nursing home or rehab facility home, or back to the hospital. All of these mean that the people taking care of the patient are now changing, as the patient moves from one point to another, and the information that the first group had, needs to move seamlessly to the second group.

Rand: Well, it sounds like a pretty complicated process that we know is not always well-coordinated. Why do patients need to pay particular attention during a care transition or handoff?

Dr. Clancy: Handoffs can be pretty dangerous because health care is an increasingly complex and fragmented process, and errors can occur when the necessary systems aren’t in place or aren’t adhered to. So for example, one of the most dangerous times for a patient is when there’s a transition between doctors, and not all of the patient’s information follows. Another big risk at any point of transition is medication error or lack of continuity of medications.

Rand: Are any particular patients more vulnerable?

Dr. Clancy: Not surprisingly, older patients, over the age of 65, are particularly affected and the reason for this is that the older you get, the more likely it is that you have more hospitalizations with a greater severity of illness. In addition to that, many older people aren’t able to return home safely and may have to go from a hospital to a long-term care or short-term rehabilitation facility. So that means the patient is moving across multiple settings and that increases the opportunity for information not to be shared seamlessly.

Rand: It also seems like patients should be especially alert during their transition out of the hospital, too.

Dr. Clancy: Well, the problem of handoffs or transitions can be even more acute at discharge. For one thing, many patients are really, really excited to be leaving the hospital, so anything that’s going to take more time they’re not terribly interested in because they want to get out of there. Often times the hospital personnel don’t have enough time to be able to educate the patient in a way that’s clear and clear for them to understand. So many people enter the discharge instructions conversation with an expectation that we can work this out all later.

Rand: So what can patients do to help with handoffs and guard against problems or mistakes?

Dr. Clancy: First, carry a list with you, at all times, of all of your medications, including over-the-counter, herbal supplements, vitamins, and so forth, so if anything happens to you, or if you have an emergency, you don’t have to rely on your memory you just always have the list with you. If you’re asked something you don’t understand, ask that it be repeated in simple language. If you’re given a new device to use, demonstrate how you think you’re supposed to use it.

Rand: Dr. Clancy, what’s the bottom line here for consumers?

Dr. Clancy: For individuals who are able, the very best advice is, be active in your own health care, which means you should take the initiative. Speak up. Don’t worry about being polite. Ask clinicians to write down any information that you’re going to need later.

Rand: For more great consumer tips, check out AHRQ’s Consumer and Patients Web site at ahrq.gov/consumer.

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