Transitional Care and Resources
The Importance Of BrightStar Transitional Care
Transitional care refers to the coordination and continuity of health care during a movement from one healthcare setting to either another or to home, called care transition, between health care practitioners and settings as their condition and care needs change during the course of a chronic or acute illness.
Current nationally endorsed measures of transitional care quality is the Care Transitions Measure (CTM), which is a 15-item survey for administration to patients after discharge from the hospital. The measure also exists as a 3-item survey. Patient responses to the survey predicts return to the emergency department and/or hospital. BrightStar Care strives for high marks and is dedicated to providing the highest quality of transitional care available.
The Transitional Care Model is designed to prevent health complications and rehospitalizations of chronically ill, elderly hospital patients by providing them with comprehensive discharge planning and home follow-up, coordinated by a “Transitional Care Nurse” who is trained in the care of people with chronic conditions.
At the time of hospitalization A BrightStar Care Nurse Can:
- Conduct a comprehensive assessment of the patient’s health status, health behaviors, level of social support, and goals
- Develop an individualized plan of care consistent with evidence-based guidelines, in collaboration with the patient and her doctors;
- Conduct daily patient visits, focused on optimizing patient health at discharge.
Source: https://www.brightstarcare.com/fredericksburg-springfield/home-care/transitional-care-services
BrightStar Care is ready to help. For more information about our disability and special needs care services in Virginia please contact us at 540-376-3131.
BrightStar Care of Fredericksburg / Springfield provides a full continuum of private duty home care services comprised of companionship, personal care, transportation, medication assistance, skilled nursing and more to improve the lives of those living with disabilities.