Managing transitions of care: How improving patient outcomes starts at the bedside


Terry Copeland, RPh, MBA, MPH

Product Leader, Outpatient Pharmacy Solutions, Cardinal Health Innovative Delivery Solutions

As I discussed in my previous article, there are many reasons that health systems should consider having an outpatient pharmacy to improve transitions of care. The way healthcare provider’s transition care from the acute to post-acute settings is critical to patient outcomes and also to patients’ perception of their overall care experience.

In this age of consumer-driven healthcare in which patients are more informed about the causes and treatment options for their conditions and their many choices of when and how to access their healthcare needs, offering seamless, convenient services can be a differentiator for patient outcomes and patient-perceived quality of care.

The foundation for high-quality transitions of care as it relates to their pharmaceutical care starts with the patient having their medications in-hand, with an understanding of how and why to take these medications, before they leave the hospital.  Having a coordinated retail pharmacy strategy is key to this, and I believe to most efficiently provide this foundation, a hospital or health provider should have an outpatient, retail pharmacy onsite. Personalized pharmacist interaction can reduce patients’ confusion over medication instructions and improve medication compliance, thereby improving patient satisfaction, reducing the probability of medication-related hospital readmissions and increasing revenue for the hospital.

One way to elevate outpatient pharmacy services to further increase quality of care is to implement a bedside discharge concierge service as a way to “bring the pharmacy to the patients” before they leave the hospital. In this model, pharmacy staff delivers medications and facilitates medication education directly at the patient’s bedside prior to discharge. This prevents the need for the patient or family to make a stop at the pharmacy on the way home upon discharge.  Research has shown that up to 30% of prescriptions are never filled1, which can negatively impact the patient’s outcome.  Having discharge prescriptions in-hand with an understanding of how and why to take the medications before they leave the health care facility is key to eliminating the “access barrier.”

In this article, I will further explain why a bedside discharge program is a strategy worth considering and the high-level process for starting this type of service.

Getting the program started

There are two key elements necessary to launch a successful bedside program: senior leadership support of the vision and hiring the right staff to deliver the program.

Senior leaders must understand the value the bedside discharge services bring to the patient population, and they must become ambassadors for promoting the program with their staff. Leaders need to ensure that physicians and all provider staff understand and are bought in to the mission and vision of the program.  In order to have a successful program, senior leadership must be committed to providing the necessary resources to start and grow the program.

Hiring the right staff is also fundamental to implementing a successful bedside program. This begins with the “quarterback” of the service, a specialized pharmacy technician sometimes referred to as a “navigator.”  The navigator is responsible for coordinating and representing the face of the program.  This “quarterback” is ultimately responsible for “selling” the benefits of the bedside program to patients to prompt their participation and for delivering the medications to the patient’s bedside. Given that this role will be interacting directly with patients and hospital staff on a daily basis, the navigator needs to have excellent people skills, bedside manner and a positive, caring attitude.

Bedside Program Implementation

Once the program foundation has been built – from Senior Leadership support to hiring the right navigators - the process of developing the service logistics and implementing the program begins.

The first step of program development involves the pharmacy’s leadership working with care transition professionals to identify patient populations that may benefit from this type of service. Traditionally, these service lines include high-risk patient populations such as cardiology, pulmonology and internal medicine. Once the high-risk patient populations are identified, the navigator is assigned to these patient care units to greet patients, explain the service and enroll patients who are interested in participating.

For patients who elect to participate in the service, the navigator works with them at their bedside to obtain pertinent information and then coordinates the receipt of prescriptions and dispensing of medications before discharge.  An additional advantage of this service is that the navigator can work with patients on any copay issues they may have as well as work with the providers on resolving/completing prior authorizations before the patient ever leaves the hospital.  This helps prevent delays in the patient receiving his/her medications.  It is a key goal of the bedside program to strategically operate so as to not add wait time to a patient’s discharge process or, in any way, disrupt the hospital’s discharge process to bring this benefit to the patient.

After the discharge plan is finalized and discharge prescriptions are written, the outpatient pharmacy fills the prescriptions.  The navigator then delivers the prescription to the patient’s bedside and a pharmacist (retail or acute) provides medication counseling before the patient leaves the hospital.

Program success

How do you know if the bedside discharge program is a success? Patients leave the hospital not only with medications in-hand but also with an understanding how and why to take the medications, many of which may be new to them. This alone has been shown to increase medication adherence, which can result in reducing readmissions and improving patient outcomes and satisfaction.

The key to a bedside discharge program’s success is due to:

  • Hospital leadership and physician support of the program
  • Nursing and case management adoption of the program
  • Communication of the service availability early in the timeframe of the patient’s stay
  • Navigators with the skills outlined above, capable of coordinating/administering the program

Overall, by gaining patients’ buy-in of the program and successfully enrolling them, hospitals and health providers can create a smooth transition of care while helping to reduce readmissions.

For example, after implementing a discharge program, a large, urban teaching facility realized a 13% decrease in average 30-day readmissions when compared to the national average in hospital units with the discharge prescription service2. Although this improvement in readmissions rate cannot be completely attributed to the bedside program, its implementation was the only change made in those patient care units during the study period. In that same facility, more than 94% of patients eligible to participate in the bedside program opted in3.

Program benefits

One way hospital staff can promote a bedside discharge concierge program to patients is to explain the many benefits of participating in it. The benefits to patients include:

  • the convenience of not having to make an additional stop on the way home from the hospital to pick up medications at a retail pharmacy
  • one-on-one pharmacist counseling for both discharge medications and medications patients were taking prior to the hospital stay
  • ease of communication between medical providers and pharmacy staff about any drug interactions or insurance coverage issues
  • resolution of any barriers to the patient taking the medication before they have been discharged (economical, insurance related or social)

The ways in which patients are choosing to address their healthcare needs are evolving and with healthcare becoming more consumer-driven, the way we address patient medications needs must evolve as well. By offering bedside discharge services and putting patient needs at the center of pharmaceutical care delivery models, healthcare providers can improve patient outcomes and satisfaction, ultimately affecting where they receive their healthcare.

There are many other types of programs and strategies that can help improve post-discharge medication needs, especially for patients who are at a high-risk for being readmitted to the hospital. Please join me in my future articles where I present a deeper look into other pharmaceutical care strategies that can help further improve patient outcomes in high-risk patient populations.