Biomaterial Database

Heart failure management across the continuum: a communication link. 2004

Annette M Walblay

Heart Failure Clinic Coordinator, Dearborn Cardiology Associates, Dearborn, MI, USA. AMWDREAM9@aol.com

Patients with heart failure often become lost in the ambulatory healthcare maze on hospital discharge. This causes fragmentation of care due to a lack of a communication link with the ambulatory setting. This article discusses a quality improvement project and addresses the use of a communication tool that helps to transition the plan of care for the heart failure patient from acute care to the ambulatory care setting. The key points focus on the continuance of the plan of care that began during hospitalization and is then extended into the ambulatory setting through care management services.

UI	MeSH Term	Description	Entries
D007400	Interprofessional Relations	The reciprocal interaction of two or more professional individuals.	Etiquette, Medical,Medical Etiquette,Relations, Interprofessional
D009720	Nurse Clinicians	Registered nurses who hold Master's degrees in nursing with an emphasis in clinical nursing and who function independently in coordinating plans for patient care.	Clinical Nurse Specialists,Clinical Nurse Specialist,Nurse Specialist, Clinical,Nurse Specialists, Clinical,Specialist, Clinical Nurse,Specialists, Clinical Nurse,Clinician, Nurse,Clinicians, Nurse,Nurse Clinician
D009737	Nursing Records	Data recorded by nurses concerning the nursing care given to the patient, including judgment of the patient's progress.	Records, Nursing,Nursing Record,Record, Nursing
D010347	Patient Care Planning	Usually a written medical and nursing care program designed for a particular patient.	Nursing Care Plans,Goals of Care,Plans, Nursing Care,Care Goal,Care Goals,Care Plan, Nursing,Care Planning, Patient,Care Plans, Nursing,Nursing Care Plan,Plan, Nursing Care,Planning, Patient Care
D010351	Patient Discharge	The administrative process of discharging the patient, alive or dead, from hospitals or other health facilities.	Discharge Planning,Discharge Plannings,Discharge, Patient,Discharges, Patient,Patient Discharges,Planning, Discharge,Plannings, Discharge
D003142	Communication	The exchange or transmission of ideas, attitudes, or beliefs between individuals or groups.	Miscommunication,Misinformation,Social Communication,Communication Programs,Communications Personnel,Personal Communication,Communication Program,Communication, Personal,Communication, Social,Communications, Social,Miscommunications,Misinformations,Personnel, Communications,Program, Communication,Programs, Communication,Social Communications
D003266	Continuity of Patient Care	Health care provided on a continuing basis from the initial contact, following the patient through all phases of medical care.	Continuum of Care,Continuity of Care,Care Continuity,Care Continuity, Patient,Care Continuum,Patient Care Continuity
D005568	Forms and Records Control	A management function in which standards and guidelines are developed for the development, maintenance, and handling of forms and records.	Records Control,Forms Control,Records Management,Controls, Records,Management, Records,Records Controls
D006333	Heart Failure	A heterogeneous condition in which the heart is unable to pump out sufficient blood to meet the metabolic need of the body. Heart failure can be caused by structural defects, functional abnormalities (VENTRICULAR DYSFUNCTION), or a sudden overload beyond its capacity. Chronic heart failure is more common than acute heart failure which results from sudden insult to cardiac function, such as MYOCARDIAL INFARCTION.	Cardiac Failure,Heart Decompensation,Congestive Heart Failure,Heart Failure, Congestive,Heart Failure, Left-Sided,Heart Failure, Right-Sided,Left-Sided Heart Failure,Myocardial Failure,Right-Sided Heart Failure,Decompensation, Heart,Heart Failure, Left Sided,Heart Failure, Right Sided,Left Sided Heart Failure,Right Sided Heart Failure
D006764	Hospitals, Community	Institutions with permanent facilities and organized medical staff which provide the full range of hospital services primarily to a neighborhood area.	Community Hospital,Community Hospitals,Hospital, Community