Shelley Dietz, director of Care Coordination [November 07 2013]
The hospital can be a confusing and scary place when you are sick, but care coordinators are there to help. They will work with the doctor and the rest of the healthcare team to find the right diagnosis, treatment and plan for you while you are in the hospital and after you leave.
Care coordinators, physicians, nurses, technicians, therapist and many others are part of the hospital patient care team. To provide the highest level of care, this team will work with you, the patient, and your family members to create a plan.
The care coordinator will look at your health conditions and ask questions about how you were living before you became sick. The care coordinator conducts a clinical review, when he or she looks at your medical chart and puts the facts together to find the best level of care to help you get well. That level of care includes where you will be treated in the hospital and what treatments match your illness. With your doctor and other care team members, the care coordinator helps to create the right hospital care plan for you.
At the same time the care coordinator works with your doctor and nurses to help plan for your hospital discharge, whether you will go to a nursing home, assisted living or your own home. Home-care agencies can help some patients, but others might need to go to a skilled nursing facility for a short time to get stronger before going home. Your discharge plan also includes medications, therapies and other services you may need to remain healthy and safe at home.
In creating this discharge plan, your care coordinator will ask you questions about how you were doing before you got sick; who you depended on for help; and if you had assistance from a home-care agency. Your care coordinator will also ask how you previously obtained medications and got to your doctor appointments.
Care coordinators know a lot about people who can help you inside and outside the hospital. They will assist you with choices about your care and treatment that best fit your needs. Having a care coordinator and a plan does not mean you will get out of the hospital sooner, it means you will leave the hospital safer, with a plan for a healthier future.