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AMA Issues 5 Patient Safety Guidelines

John Commins, for HealthLeaders Media, February 11, 2013

"Inpatient teams face important limitations in ensuring safe transitions to ambulatory settings," the report continues. "Given the great variability of inpatient and ambulatory care team resources and capabilities, there can be no 'one-size fits all' model for safe care transitions; but certain tasks during care transitions are probably best carried out by members of the ambulatory rather than the inpatient care team, since the ambulatory practice will be responsible for providing ongoing care to the patient in the ambulatory setting."

The five responsibilities outlined in the report include:

  1. Assessment of the patient's health;
  2. Goal-setting to determine desired outcomes;
  3. Supporting self-management to ensure access to resources the patient may need;
  4. Medication management to oversee needed prescriptions;
  5. Care coordination to bring together all members of the health care team.

The report was issued this month shortly after Medicare announced that it will accept the newly created Current Procedural Terminology codes for care coordination to pay physicians for the management of patients who have recently been discharged from a hospital or skilled nursing facility, the AMA said.

The AMA's CPT Editorial Panel built the codes to catalog care management services, including time spent talking about a care plan, connecting patients to community services, transitioning them from inpatient settings and preventing readmissions.

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4 comments on "AMA Issues 5 Patient Safety Guidelines"


Susanne Cookson (2/19/2013 at 3:54 PM)
In Canada we are pilot for CHF patients testing a patient education portal designed to provide a step-wise approach to providing education needed for patients to take personal ownership and control after they are discharged from hospital. The program provides education and health trackers for Congestive Heart Failure patients. It provides clear direction in terms of when to call the hospital, what to expect and norms, etc. the site records medication adherence through a meds reminder system. To ensure people use it, there is a rewards points system whereby patients earn points for engaging in the materials, answer comprehension questions, and using the tracker and medication reminders. Aggregate data is provided back to the hospital. The goal is to ensure that patients are well-informed post discharge and equipped to manage their condition.

John Fraser, MD (2/13/2013 at 11:55 AM)
This did not happen as often before healthcare became so compartmentalized. There was a time when physicians admitted most patients from their offices or the ED, managed their inpatient care, then resumed outpatient follow up care. The various handoffs these days increase the risk of important information not being transferred, not to mention multiple providers at different times not noticing subtle changes in the patient's condition.

Natalie Osborne (2/13/2013 at 8:33 AM)
As a nurse manager in a SNF, I have far too many times needed to send a patient back to the hospital because they are too unstable. If patients were stable when they left the hospital, I doubt we would see so many readmissions. It would also be beneficial for the patient coming to the SNF to be formally admitted to the hospital so they may receive the Medicare A benefit. So many patients come to the SNF and think "well, I was in the hospital, I had to be admitted" and that is not the case. Many times they are in observation only and if they are in observation for 3 nights, they will not receive the Medicare benefit.