Identifying Challenges Associated With the Care Transition Workflow From Hospital to Skilled Home Health Care: Perspectives of Home Health Care Agency Providers.
Older adults discharged from the hospital to skilled home health care (SHHC) are at high risk for experiencing suboptimal transitions. Using the human factors approach of shadowing and contextual inquiry, we studied the workflow for transitioning older adults from the hospital to SHHC. We created a representative diagram of the hospital to SHHC transition workflow, we examined potential workflow variations, we categorized workflow challenges, and we identified artifacts developed to manage variations and challenges. We identified three overarching challenges to optimal care transitions-information access, coordination, and communication/teamwork. Future investigations could test whether redesigning the transition from hospital to SHHC, based on our findings, improves workflow and care quality.
a Armstrong Institute for Patient Safety and Quality , Johns Hopkins University , Baltimore , Maryland , USA.
Mahiyar
M
Nasarwanji
b Department of Industrial and Systems Engineering , University of Wisconsin-Madison , Madison , Wisconsin , USA.
Nicole E
NE
Werner
c Johns Hopkins Home Care Group , Baltimore , Maryland , USA.
Kimberly
K
Carl
c Johns Hopkins Home Care Group , Baltimore , Maryland , USA.
Dawn
D
Hohl
d Division of Geriatric Medicine and Gerontology, Department of Medicine , Johns Hopkins University , Baltimore , Maryland , USA.|e Department of Community and Public Health , Johns Hopkins School of Nursing , Baltimore , Maryland , USA.|f Department of Health Policy and Management , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.
Bruce
B
Leff
a Armstrong Institute for Patient Safety and Quality , Johns Hopkins University , Baltimore , Maryland , USA.|f Department of Health Policy and Management , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.|g Department of Anesthesiology and Critical Care , Johns Hopkins University , Baltimore , Maryland , USA.
Ayse P
AP
Gurses
a Armstrong Institute for Patient Safety and Quality , Johns Hopkins University , Baltimore , Maryland , USA.|d Division of Geriatric Medicine and Gerontology, Department of Medicine , Johns Hopkins University , Baltimore , Maryland , USA.|h Department of Clinical Investigation , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.
Alicia I
AI
Arbaje
D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D003299:Cooperative Behavior; D005260:Female; D018574:Home Care Agencies / Q000592:standards* / Q000639:trends; D018576:Home Health Aides / Q000523:psychology; D006761:Hospitals / Q000592:standards; D006801:Humans; D008297:Male; D064691:Nurses, Community Health / Q000523:psychology; D010351:Patient Discharge / Q000592:standards; D010360:Patient Transfer / Q000379:methods / Q000592:standards; D010465:Perception; D036301:Qualitative Research; D000069341:Transitional Care / Q000592:standards*; D057188:Workflow
care transitions; communication; frail elderly; home health care; human factors engineering; qualitative research; teamwork