Discharge Planning: Home Health Agencies Discharge Summary

This powerful app provides a summary of key information for patient health and successful post-discharge care which can be necessary when a patient or resident leaves a care setting, such as following a hospital stay. Health care professionals, social workers, hospital patient advocates, other staff on the health care team, the family caregiver and even the patient participate in the planning process. They may work together to plan discharge activities as part of a multidisciplinary team. The plan may include specific follow-up care, documentation of underlying medical conditions, previous serious incidents, patient condition trends and so forth. Some practices have a dedicated case manager or discharge planners who work with HHAs to provide Home Health care to the patient with certain care needs.

Planning for these transitions, ensuring that everyone understands the discharge instructions and medication treatment, and assuring that discharge goes smoothly can greatly improve patient outcomes and reduce the hospital readmission rate for patients. Whether you are hospital staff or a rehabilitation facility providing transitional care, this discharge plan becomes a part of the patient medical record. Others in the patient family may want to access this app, learn from what is included in the app, ask questions and customize it to suit their needs. You won't forget the important details when you can easily access these instructions, safely recorded in the cloud or available in PDF format. That hospital stay isn't the end of the story. Don't let your patient or their caregivers leave the hospital under-informed or overwhelmed.