Posted June 08, 2018

COACHING MINUTE: Care Transitions Calls Remove Barriers to Patient Compliance

By Tonia Breckenridge, MBA

While coaching at one of my partner organizations recently, their leadership team and I discovered through their care transition call process that their DME (Durable Medical Equipment) provider wasn't making timely deliveries of ordered equipment. The delay was making it difficult for patients to follow through on their discharge instructions.

We reviewed their reports in their Patient Call ManagerTM, Studer Group's clinical call system, to determine if there was a trend of late deliveries leading to patient noncompliance. We found that there was, and we quickly notified the DME partner of the problem. From there, we were able to proactively resolve this issue to ensure patients have the tools and equipment to comply with their doctors' orders once they are comfortably back home.

In my experience, transitions of care from one setting to another can be fraught with communication breakdowns. So, how do you know that your patients have received everything they need once they are at home following an inpatient stay? Did they get their shower chair, oxygen or walker? One tactic I recommend for ensuring patients have exactly what the doctor ordered is to make a care transition call within two days of discharge.

Beyond that, it is vital to make care transitions calls as impactful as possible. It's not enough just to call. When connecting with patients after they get home, you not only want to check on how well they are managing their discharge instructions and follow-up care, but you should also ask about upcoming home health visits and DME delivery and setup. Consider reviewing what was ordered and asking a few targeted questions to determine whether they have everything they need. Sometimes patients don't know what questions to ask, and healthcare providers must take the lead to proactively identify any barriers.

In advance of the conversation, callers should also review discharge instructions and patient information to incorporate relevant items into the discussion. From there, set up workflows to escalate any concerns uncovered during the call. It was by following these key steps that my partner organization was able to proactively sidestep a DME issue that could have easily impacted patient safety.


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