TABLE 1

Draft Transitions of Care Quality Measures Evaluated by the Multistakeholder Delphi Panel

Brief DescriptionFull MeasureRecommended for Use (Rationale for Exclusion)
Documentation of postdischarge appointmentsChildren discharged from the hospital should have the date and time of all follow-up appointments documented in their hospital medical record before discharge.No (not endorsed by Delphi panel)
Transition needs assessmentChildren admitted to the hospital for >24 h should have an assessment of their transition needs documented in their hospital medical record before discharge.No (measure could not be operationalized reliably from the medical record and was not included in the medical record abstraction)
Hospital-to-home transition record qualityChildren admitted to the hospital should have documentation in their hospital medical record of a transition record that contained all of the following elements:Yes
a. Admission and discharge diagnoses
b. Medication list at discharge
c. List of follow-up appointments
d. 24/7 telephone contact number if problems arise
e. Number to call for assistance getting needed appointments
f. Admit and discharge dates
g. Pending test results
h. Follow-up tests that need to be completed
i. Immunizations given
Timely discharge communication between providersChildren discharged from the hospital should have documentation in their hospital medical record that the receiving outpatient follow-up provider was contacted (by phone, fax, or e-mail) by a hospital provider between 24 h before and 48 h after the patient’s discharge.Yes
ICU-to-floor transition note qualityHospitalized children transferred between the ICU and general inpatient floor should have the following elements documented in a transition note:Yes
a. Current problem list
b. Treatment plan for each problem