日本財団 図書館


Day Two

 

9:30-10:30

Overview of Risk and the Use of Assessment Forms

Assessment of risk post discharge has been a constant challenge for discharge planners. Shorter length of stay have lead to a variety of approaches of assessment that will ensure that patients have an adequate assessment before they leave the setting. The use of flow sheets, referral/history forms and guidelines as diagnostic tools does not ensure that the risk information is addressed. The post partum visit flow sheet is an example of a risk assessment that originally quantified the degree of risk of patient and/or family. This was modified into a yes/no format with comments that replaced actual, risk scores: This was seen as a more simplified version to indicate the degree of risk. If the risk was low, the patient was not followed up and cost savings were achieved with this approach. A classic example in Canada was the cancellation of well baby visits while maintaining only those with high risk. After two incidences of infant mortality, the government re-instituted home visiting and increased the length of stay from 24 hours to 48 hours for new mothers.

 

Risk factors are elements that predispose people to poorer health. The population health promotion model looks at risk in a broader way than the specific assessment forms, post discharge. It moves the discussion to a full range of factors and conditions that determine health and the ability to cope with an ill relative. Health determinants such as income and social status, social support networks, education, employment, physical environment, coping skills, and the availability of health services all must be taken into account when assessing the degree of risk when planning discharge.

 

Naylor (1999) demonstrated that with the population of elderly as risk for readmission good discharge planning and home follow up by an advance practice gerontological nurse reduced hospital re-admissions, increased the length of time between discharge and readmission and reduced health care costs.

 

High risk individuals include those at risk because of advanced age, multiple and acute chronic illness, including congestive heart failure, chronic obstructive pulmonary disease and coronary artery disease.

 

10:30-11:30

Transitions Across Various Continuous Care Settings

There are large differences between countries in admissions and discharge to and from nursing homes. Various policies, payment schemes, care patterns and routine referrals are influential and can be studies with cross national data.

 

 

 

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