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Why and how hospitals need to modernize care transitions

Modernizing care transitions in hospitals has significant financial benefits. Here are a few reasons why hospitals need to update their care transitions processes:


  1. Reduce readmissions: According to a report by the Agency for Healthcare Research and Quality (AHRQ), unplanned readmissions account for over $17 billion in annual healthcare costs in the US. Modernizing care transitions can help reduce the likelihood of readmissions and lower healthcare costs.

  2. Decrease length of stay: A study published in the Journal of Hospital Medicine found that care transition interventions reduced the length of hospital stays by an average of 0.44 days per patient, resulting in a cost savings of $380 per patient.

  3. Improve patient outcomes: Modernizing care transitions can improve patient outcomes and reduce the likelihood of adverse events. A study published in the Journal of the American Geriatrics Society found that interventions to improve care transitions led to a 30% reduction in adverse drug events.

  4. Increase patient satisfaction: A smooth care transition can improve patient satisfaction, an important factor in hospital reimbursements. CMS now ties Medicare payments to HCAHPS scores. Improving the discharge process can improve patient satisfaction, thus improving the hospital's HCAHPS scores.

  5. Meet regulatory requirements: CMS requires hospitals to have a robust discharge planning process. Inadequate care transitions may lead to violations of these regulations, leading to financial penalties.

Modernizing care transitions is beneficial not only to patients but also to hospitals' bottom line. It can help reduce readmissions, decrease length of stay, improve patient outcomes, increase patient satisfaction, and meet regulatory requirements, all of which can save hospital costs.


Generative AI like Edgility's EdgeAi can be a powerful tool to help hospital care transition teams improve patient outcomes and operational efficiency. Here are some ways in which EdgeAi can be helpful:


  • Prediction and prevention of readmissions: EdgeAi analyzes data from various sources, such as electronic health records (EHRs), wearables, and other patient feedback devices, to identify patients at risk of readmission. EdgeAi's analysis allows care teams to intervene proactively and prevent readmissions, improving patient outcomes and reducing healthcare costs. (Reference: "Reducing hospital readmissions with predictive analytics," Healthcare IT News)

  • Personalized care plans: EdgeAi uses machine learning algorithms to identify patterns in patient data to generate personalized care plans that consider the patient's medical history, preferences, and other factors. EdgeAi's ML helps care transition teams provide targeted and effective care, leading to better outcomes. (Reference: "Personalized care plan for hospital to home transitions," BMC Medical Informatics and Decision Making)

  • Real-time communication and collaboration: EdgeAi facilitate real-time communication and collaboration among care team members, allowing for more coordinated and efficient care transitions. For example, EdgeAi alerts care teams when a patient is ready for discharge, ensuring everyone is on the same page. (Reference: "Improving communication and care transitions with health information exchange and interface engines," Journal of Healthcare Information Management)

  • Workflow optimization: EdgeAi analyzes data on care transition workflows to identify inefficiencies and suggests optimizations that improve operational efficiency and reduce costs. For example, EdgeAi can identify bottlenecks in the discharge process and recommend changes to eliminate them. (Reference: "Using artificial intelligence to streamline hospital workflows," Harvard Business Review)

  • Continuous learning and improvement: EdgeAi continuously learn from patient data to improve care transition processes. By analyzing outcomes, patient satisfaction, and other metrics, EdgeAi identifies improvement areas and suggests changes that can lead to better outcomes at lower costs. (Reference: "Artificial intelligence in healthcare: past, present and future," Journal of Medical Systems)


In summary, generative AI like Edgility's EdgeAi is a valuable tool for hospital care transition teams, helping improve patient outcomes, optimize workflows, and reduce costs.

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