The movement of patients between health care practitioners.
Identify your selected transition of care. ——” Transitions of care” refer to the movement of patients between health care practitioners, settings, and home as their condition and care need change. For example, a patient might receive care from a primary care physician or specialist in an outpatient setting, then transition to a hospital physician and nursing team during an inpatient admission before moving on to yet another care team at a skilled nursing facility. Finally, the patient might return home, where he or she may receive care from a visiting nurse or support from a family member or friend.
Explain how you, as a nurse leader, along with your healthcare team, would apply systems thinking when providing a transition of care aligned with the IHI Quadruple Aim framework in order to improve it. Explain what the fourth aim in your strategy would be and why.
These are the four areas:
Experience of care
Per capita cost
Care team well-being
Describe the key stakeholders that might be involved in this transition of care and how you would engage and influence them to improve the transition of care processes.
Explain how systems thinking would inform your improvement plan for your transition of care.