title: [ANMCO Position paper: Hospital discharge planning].
abstract: Hospital discharge is often poorly standardized and is characterized by discontinuity and fragmentation of care, putting patients at high risk of post-discharge adverse events and early readmission. The present ANMCO position paper reviews the modifiable components of the hospital discharge process related to adverse events or rehospitalizations and suggests the optimal methods for redesign the whole discharge process. The key principles for proper hospital discharge or transfer of care acknowledge that hospital discharge:- is not an isolated event, but a process that has to be planned immediately after admission, ensuring that the patient and the caregiver understand and contribute to the planned decisions as equal partners;- is facilitated by a comprehensive systemic approach that begins with a multidimensional evaluation process;- must be organized by an operator who is responsible for the coordination of all phases of the hospital patient pathway, involving afterwards the physician and transferring to them the information and responsibility;- is the result of an integrated multidisciplinary team approach;- uses appropriately the transitional and intermediate care services;- is carried out in an organized system of care and continuum of services;- programs the passage of information to after-discharge services.
authors.affiliation: U.O.C. Cardiologia-UTIC, Ospedale L. Parodi Delfino, Colleferro (RM).
authors.forename: Mauro
authors.initials: M
authors.lastname: Mennuni
authors.affiliation: U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania.
authors.forename: Michele Massimo
authors.initials: MM
authors.lastname: Gulizia
authors.affiliation: Unità Integrata Scompenso Cardiaco, Ospedale di Assisi, Assisi (PG).
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Alunni
authors.affiliation: U.O. Cardiologia-UTIC, Ospedale San Giuseppe da Copertino, Copertino (LE).
authors.forename: Antonio Francesco
authors.initials: AF
authors.lastname: Amico
authors.affiliation: S.C. Malattie Cardiovascolari, Nuovo Ospedale San Luca, Lucca.
authors.forename: Francesco Maria
authors.initials: FM
authors.lastname: Bovenzi
authors.affiliation: U.O.C. Cardiologia Interventistica, Ospedale SS. Annunziata, Cosenza.
authors.forename: Roberto
authors.initials: R
authors.lastname: Caporale
authors.affiliation: U.O.C. Cardiologia-UTIC, Presidio Ospedaliero San Filippo Neri, Roma.
authors.forename: Furio
authors.initials: F
authors.lastname: Colivicchi
authors.affiliation: S.C. Centro Cardiovascolare, Azienda Sanitaria Universitaria Integrata, Trieste.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.affiliation: U.O. Cardiologia, Istituti Ospitalieri, Cremona.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Tano
authors.affiliation: U.O. Cardiologia, ISMETT, Palermo.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Egman
authors.affiliation: Riabilitazione Cardiologica, AOU Careggi, Firenze.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fattirolli
authors.affiliation: U.O. Cardiologia, Ospedale Civile Augusto Murri, Fermo.
authors.forename: Domenico
authors.initials: D
authors.lastname: Gabrielli
authors.affiliation: U.O.C. Cardiologia, P.O. Cervello, A.O. Riuniti Villa Sofia-Cervello, Palermo.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Geraci
authors.affiliation: U.O. Cardiologia-UTIC, Ospedale San Luca, Vallo della Lucania (SA).
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gregorio
authors.affiliation: Cardiologia e Riabilitazione Cardiologica, A.O. San Giovanni-Addolorata, Roma.
authors.forename: Gian Francesco
authors.initials: GF
authors.lastname: Mureddu
authors.affiliation: S.O.C. Cardiologia, Ospedale Castelli, Verbania.
authors.forename: Federico
authors.initials: F
authors.lastname: Nardi
authors.affiliation: S.C. Centro Cardiovascolare, Azienda Sanitaria Universitaria Integrata, Trieste.
authors.forename: Donatella
authors.initials: D
authors.lastname: Radini
authors.affiliation: Prevenzione e Riabilitazione Cardiopatico, Azienda Ospedaliera S. Anna e S. Sebastiano, Caserta.
authors.forename: Carmine
authors.initials: C
authors.lastname: Riccio
authors.affiliation: U.O. Cardiologia, Ospedale dell'Angelo, Mestre (VE).
authors.forename: Fausto
authors.initials: F
authors.lastname: Rigo
authors.affiliation: U.O. Cardiologia e Cure Intensive Cardiologiche, Ospedale Generale Regionale, P.O. U. Parini, Aosta.
authors.forename: Marco
authors.initials: M
authors.lastname: Sicuro
authors.affiliation: U.O. Cardiologia, Ospedale Bellaria, Bologna.
authors.forename: Stefano
authors.initials: S
authors.lastname: Urbinati
authors.affiliation: U.O. Cardiologia, Ospedale dell'Angelo, Mestre (VE).
authors.forename: Guerrino
authors.initials: G
authors.lastname: Zuin
mesh_terms: D000359:Aftercare / Q000592:standards; D000465:Algorithms; D006801:Humans; D010351:Patient Discharge / Q000592:standards*; D063886:Patient Discharge Summaries / Q000592:standards