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21. Resources and Tools To Improve Discharge and Transitions of Care and Reduce Readmissions | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/about/areas/improve-discharge.html
    August 01, 2024 - Resources To Cut Readmissions, Promote Patient Self-Management AHRQ's RED Toolkit Inspires Improved Patient … Discharge at Nacogdoches Memorial Hospital AHRQ's RED Toolkit Leads to Lower Readmissions, Better Care … Transitions in Two Texas Hospitals IDEAL Discharge Planning Improving the Emergency Department Discharge … AHRQ PSNet Perspective: Transitions in Care, In Conversation With Eric Coleman AHRQ PSNet Primer:  Discharge … Planning and Transitions of Care Related Patient Safety and Quality Resources and Tools Cross-Cutting

22. Chapter 6. Measure Maps and Profiles (continued, 15) | Agency for Healthcare Research and Quality
    www.ahrq.gov/ncepcr/care/coordination/atlas/chapter6n.html
    June 01, 2014 - The development, validity and application of a new instrument to assess the quality of discharge planning … Discharge planning quality from the carer perspective. Qual Life Res 2000;9:1005-13. … The development, validity and application of a new instrument to assess the quality of discharge planning … The development, validity and application of a new instrument to assess the quality of discharge planning … Discharge planning scale: Community physicians' perspective. J Hosp Med 2008;3(6):455-64. 3.

23. Inpatient-to-Outpatient Transitions | Agency for Healthcare Research and Quality
    www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-care-transitions5.html
    June 01, 2023 - to improve the safety of the inpatient-to-outpatient transition and engage patients and families in discharge … planning through a novel IDEAL Discharge Planning strategy. 93 This systematic framework focuses on … : I ncluding patients and families as full partners in discharge planning, D iscussing with patients

24. Patient and Family Engagement | Agency for Healthcare Research and Quality
    www.ahrq.gov/hai/cusp/modules/patient-family-engagement/sl-pat-fam.html
    September 01, 2013 - IDEAL Discharge Planning Slide 17. What Is IDEAL Discharge Planning? 1 Slide 18. … Benefits of IDEAL Discharge Planning for Clinicians 1 Slide 19. IDEAL Discharge Slide 20. … IDEAL Discharge Planning Return to Contents   Slide 17. What Is IDEAL Discharge Planning? … Benefits of IDEAL Discharge Planning for Clinicians 1 Improves accuracy of information about the … IDEAL Discharge Planning is an effective tool for ensuring patient and family member engagement and education

25. Section 5, Tables 8 and 9 (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-131-section-5-table-8-9.pdf
    January 01, 2013 - Discharge planning from hospital to home. … The intervention group received: (1) a comprehensive, user-friendly patient discharge form; (2) electronic … transfer of the patient discharge form to nurses at the primary care provider site; (3) telephone … Forty- Evaluating hospital discharge planning: a randomized clinical trial. … Public reporting of discharge planning and rates of readmissions.

26. Information to Help Hospitals Get Started
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/howtogetstarted/How_to_Use_Guide_Ldr_Slide_508.pptx
    July 23, 2010 - Involving patients and families in discharge planning and plans for safe care at home. … Nurs Adm Q 2006;30(2):112–22.  14 Why focus on discharge planning? … A review of discharge planning research of older adults 1990-2008. … Hospital discharge planning for frail older people and their family. … Discharge planning from hospital to home. Cochrane Database Syst Rev 2010;20(1):CD000313.

27. Patient and Family Engagement | Agency for Healthcare Research and Quality
    www.ahrq.gov/hai/cusp/modules/patient-family-engagement/notes.html
    September 01, 2013 - IDEAL Discharge Planning Slide 17. What Is IDEAL Discharge Planning? 1 Slide 18. … IDEAL Discharge Planning The following section discusses the IDEAL Discharge Planning tool and how … to use it in discharge planning. … What Is IDEAL Discharge Planning? … Benefits of IDEAL Discharge Planning for Clinicians 1 Say: Using the IDEAL discharge planning process

28. Information to Help Hospitals Get Started (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/howtogetstarted/How_to_Use_Guide_Ldr_Slide_508.pdf
    June 02, 2025 - Working with Patients and Families at the Bedside: Care Transitions from Hospital to Home: IDEAL Discharge … Planning 11 Information to Help Hospitals Get Started Why work with patients and families as … planning? … planning – Changes in medicines before and after discharge – Inadequate preparation for patients and … Why focus on discharge planning? Moving forward What do we need from you?

29. Cusp Patient Family Engagement Facilitator Notes (doc file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/modules/patfamilyengagement/CUSP_Patient_Family_Engagement_Facilitator_Notes.docx
    June 02, 2025 - Slide 15 SAY: The following section discusses the IDEAL Discharge Planning tool and how to use it … in discharge planning. … Slide 17 SAY: Using the IDEAL discharge planning process helps ensure that clinicians, patients … ASK: · What components of the IDEAL discharge planning process were captured in this video? … Care Transitions from Hospital to Home: IDEAL Discharge Planning Explores the components of a discharge

30. Cover slide
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/modules/patfamilyengagement/CUSP-Patient-Family-Engagement.pptx
    May 01, 2013 - family for calling attention to any issue raised Invite them to continue asking questions IDEAL Discharge … Planning What is IDEAL Discharge Planning? … Planning for Clinicians1 Improves accuracy of information about the patient’s condition and discharge … members of the health care team impacts health outcomes and patient and family satisfaction IDEAL Discharge … Planning is an effective tool for ensuring patient and family member engagement and education Organizations

31. Transitions of Care | Agency for Healthcare Research and Quality
    www.ahrq.gov/topics/transitions-care.html
    in Safe Transitions Across Ambulatory Settings Care Transitions from Hospital to Home: The IDEAL Discharge … Planning MATCH Toolkit (Medications at Transitions and Clinical Handoffs) Taking Care of Myself:

32. Coaching in the Hospital | Agency for Healthcare Research and Quality
    www.ahrq.gov/es/patient-safety/settings/hospital/resource/nicu/coaching.html
    December 01, 2013 - Prioritize patient visits for the day: New patients—while discharge planning should always "begin … Discharge planning (insurance coverage, pediatrician contact information and appointment date, CPR education

33. Coaching in the Hospital | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/settings/hospital/resource/nicu/coaching.html
    December 01, 2013 - Prioritize patient visits for the day: New patients—while discharge planning should always "begin … Discharge planning (insurance coverage, pediatrician contact information and appointment date, CPR education

34. Making Healthcare Safer Practices: 15. Care Transitions (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/research/findings/making-healthcare-safer/mhs3/care-transitions-1.pdf
    March 01, 2020 - AB “Discharge Planning” OR "Patient Discharge" OR "Patient Transfer" OR "Patient Handoff"))) (( … AB “Discharge Planning” OR "Patient Discharge" OR ((AB “Care Transitions Intervention” OR “CTI”) … AB “Discharge Planning” OR "Patient Discharge" OR "Patient Transfer" OR "Patient Handoff"))) (( … Discharge” OR “Patient Transfer” OR "Patient Handoff”) OR (AB “Discharge Planning” OR "Patient Discharge … AB “Discharge Planning” OR "Patient Discharge" OR "Patient Transfer" OR "Patient Handoff"))) ((

35. Tool 1: Overview | Agency for Healthcare Research and Quality
    www.ahrq.gov/es/patient-safety/settings/hospital/red/toolkit/redtool1.html
    March 01, 2013 - that national quality organizations have begun to set standards to address some of the deficiencies of discharge … planning. … A Cochrane review of discharge planning interventions indicated that a number of interventions did not … of integrating the discharge education functions into the duties of the staff nurse responsible for patient … discharge versus a strategy of hiring dedicated discharge educators to perform these functions.

36. Tool 1: Overview | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/settings/hospital/red/toolkit/redtool1.html
    March 01, 2013 - that national quality organizations have begun to set standards to address some of the deficiencies of discharge … planning. … A Cochrane review of discharge planning interventions indicated that a number of interventions did not … of integrating the discharge education functions into the duties of the staff nurse responsible for patient … discharge versus a strategy of hiring dedicated discharge educators to perform these functions.

37. Designing and Delivering Whole-Person Transitional Care: The Hospital Guide to Reducing Medicaid Readmissions - Toolbox (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/medicaidreadmitguide/medread-tools.pdf
    July 28, 2016 - Incorporate into regular discharge planning assessment and referrals. …  Have a documented discharge planning process, approved by the hospital’s governing board;  Provide … discharge planning for all inpatients, observation patients, and certain ED patients;  Analyze and … Time Required Incorporate into regular discharge planning assessment and referrals. … 2015 proposed CMS Discharge Planning Conditions of Participation (Medicare and Medicaid programs revision

38. Patient Family Engagement PowerPoint Content and Alternate Text | Agency for Healthcare Research and Quality
    www.ahrq.gov/hai/cusp/modules/patient-family-engagement/alt-text-tab.html
    September 01, 2013 - Discharge Example   A patient surrounded by a health care team Slide 17 What is IDEAL Discharge … Planning? … family’s goals, preferences, observations, and concerns   Slide 18 Benefits of IDEAL Discharge … Planning for Clinicians 1 Improves accuracy of information about the patient’s condition and discharge … Planning 1 SBAR (Situation — Background — Assessment — Recommendation) 2   Slide 29

39. Tool Overview | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/settings/hospital/resource/guide/tools.html
    October 01, 2016 - Incorporate into regular discharge planning assessment and referrals. 4 Tool 10 Discharge

40. Seamless Care: Safe Patient Transitions from Hospital to Home (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Spehar.pdf
    April 18, 2004 - An expert panel focus group provided insights into discharge planning processes. … Discharge planning and case management at this hospital are organized by service. … Patient problems and nurse interventions during acute care and discharge planning. … Predictors of elder and family caregiver satisfaction with discharge planning. … Racial differences in discharge planning. Health Social Work 1996; 21:131–9. 54.