Reference: CMS Specifications Manual for 2012
Outpatient Setting: Emergency Department
Description: This measure is used to assess the percentage of patients, regardless of age, discharged from an emergency department (ED), or their caregiver(s), who received a transition record at the time of ED discharge including, at a minimum, all of the specified elements. A transition record is a core, standardized set of data elements related to patient's diagnosis, treatment, and care plan that is discussed with and provided to patient or caregiver(s) in printed or electronic format at the time of emergency department (ED) discharge.
Rationale: Providing a detailed transition record at the time of ED discharge enhances the patient's preparation to self-manage post-discharge care and comply with the post-discharge treatment plan. Transitional care ensures coordination and continuity of health care as patients transfer between locations or levels of care in the same location. Multiple studies have linked uncoordinated transitions between sites of care and caregivers, even within the same institution, to higher hospital readmission rates, medical errors, duplication of services, and wasted resources.
Transition Record must contain
- Major procedures & tests performed during ED visit,
- Principal diagnosis at discharge OR chief complaint,
- Patient instructions,
- Plan for follow-up care,
- List of new medications and changes to continued meds ...
