Feb 15, 2023
High-quality care transitions are a key element of the province’s new Connected Care strategy, which aims to reduce reliance on hospital care in Saskatchewan and shorten emergency department wait times.
Research evidence shows that improving how patients move from hospital to the community – and planning for discharge – can help reduce inappropriate lengths of stay in hospital and readmission rates.
The framework for High-Quality Care Transitions is adapted from Burke and colleagues’ work on Ideal Transitions in Care and lists eight factors that contribute to reducing our reliance on hospital care:
- Medication safety
- Advanced care planning
- Self management and health promotion
- Coordinated transition planning
- Post transition monitoring, management and support
- Social and community support
- Information completeness, continuity and timeliness
- Functional decline prevention
To help individuals and teams in Saskatchewan, we have pulled together a short guide on the best evidence around each domain, related tools and resources, and identified some examples and case studies to provide inspiration for action.
This guide is one of several resources HQC is developing to support the system as it implements the Connected Care strategy.
