Using Predischarge Appointments to Improve Continuity of Care for High-Risk Patients

Continuity of care in psychiatric post‐ward outpatient services – conceptions of patients and personnel concerning factors contributing to the continuity of care

“…The recommendations of a national research project for those with schizophrenia (Salokangas et al 2000) state, among other things, that the drawing-up of the care plan, its realization at hospital, and especially the patient's transfer to outpatient services should take place in close cooperation with the outpatient services and the patient's family. Sullivan et al (1981) also pointed out that the continuity of care is improved by efficient coordination of the inpatient period and the outpatient services. The study further showed that the patient's participation in outpatient care and after-care was improved by the establishment of the patient's relationship with the outpatient therapist during the period of hospitalization.…”

“…2000) state, among other things, that the drawing‐up of the care plan, its realization at hospital, and especially the patient's transfer to outpatient services should take place in close cooperation with the outpatient services and the patient's family. Sullivan et al . (1981) also pointed out that the continuity of care is improved by efficient coordination of the inpatient period and the outpatient services.…”

Discharging psychiatric patients from hospital

“…Sullivan and Bonovitz (1981) found that subsequent out-patient attendance was improved by offering the first appointment within 3 days of discharge. A nurse discharge coordinator had no positive effect on readmission rates, on post-discharge well-being or on patient satisfaction ratings (Walker et al, 2000).…”

Meaningful linkage practices: Challenges and opportunities

“…There are widely varymg estimates of the extent of ineffective linkages to outpatient mental health treatment after discharge. It has been estimated that from 22 to 90 percent of psychiatric patients fail to attend their initial outpatient appointments or to receive treatment proximal to their hospital discharge (Bogin, Anish, Taub, and Kline, 1984; Center for Research on the Organization and Financing of Care for the Severely Mentally Ill, 1994;Stickney, Hall, and Gardner, 1980;Sullivan and Bonovitz, 1981;Tessler and Mason, 1979;Wolkon, 1970;Zeldow and Taub, 1981). Generally, less than 50 percent of discharged psychiatric patients make a successful transition to outpatient care.…”

“…Bridging strategies are characterized by communication with patients and participation in care by inpatient and outpatient clinicians and family members or other support persons (Boyer, McAlpine, and Pottick, 1996). Scheduling outpatient appointments within a few days of discharge is the most common pointof-entry approach (Axelrod and Wetzler, 1989;Sullivan and Bonovitz, 1981;Wolkon, Peterson, and Rogawski, 1978). Not relymg on patients to make appointments is important but hardly sufficient for linking patients successfully to community care, especially for those patients with complex needs and past histories of noncompliance.…”