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Providing better coordination of care may involve a new attitude toward patient care as well as system-level changes. Here are some ideas that emerged from the collaborative on Improving Service in Health Care, sponsored by the Institute for Healthcare Improvement and The Picker Institute in Boston:
To unify and coordinate care in your system as experienced by patients:
- Identify a spokesperson for the medical team: physician and nurse (give patient card with beeper, e-mail, etc.).
- Share care plans and clinical pathways with patients so they know what to expect and when.
- Have a "call return" time service guarantee.
To ensure smooth transitions between care settings and other caregivers:
- Share map of the entire process of care developed from the perspective of the patient.
- Check with patient and family for understanding of referral processes.
- Provide 24-hour prescription refill request lines.
- Fax orders and clinical information between settings.