Providing optimal healthcare from admission to discharge has been increasingly complex as patient care has changed from individual consultation to multidisciplinary teamwork which requires collaboration between healthcare providers across healthcare settings. Without proper oversight, fragmented information, and communication lead to inappropriate care such as ordering of unnecessary investigations, and treatments with little to no value to patients. Inadequate discharge planning and follow-up care also lead to preventable hospital readmissions.
Thus, this project aims to ensure that the inpatient discharge process maximizes patient outcomes while optimizing resource use, primarily focuses not only on timely and coordinated across care teams and settings but also to ensure consistent care after discharge. The approach is designed to emphasize multidisciplinary teamwork among providers during the patient’s peri-admission care cycle, working together for seamless patient transitions within the hospital and after discharge, reducing communication gaps and ensuring that information is shared among hospital staff, primary care providers and post-acute care teams.
