2.5.09 Follow-up treatment Estimated reading: 2 minutes 686 views Authors Goal and purpose Patient information, application procedure, selection and appointment coordination. Area of application Follow-up treatment is an integral part of the treatment of illnesses that cannot be completed in the clinic alone, e.g. femoral neck fractures, stomach or pancreas operations. For this reason, the clinic should ensure that the application is submitted at an early stage so that the AHB can be started in good time. Description of the The application for AHB should be submitted in good time in a suitable form. Suitable forms include In-house discharge management defined treatment paths or the social visit described above. Discharge management should include provisions for the involvement of social services. In the case of major operations, the social services should ideally be involved from the outset so that the application for AHB can be made during the patient's stay at the clinic. In some clinics, discharge is planned within the first 48 hours of admission and the social services are also informed in this context. The reminder to apply for AHB could be supported electronically. This support must be low-threshold and could, for example, be integrated into existing treatment pathways. If it is not possible to apply for AHB directly, this must be explicitly discussed with the patient and noted in the doctor's letter. An additional safeguard for post-inpatient treatment or aftercare appointments (removal of stitches etc.) could be to include the application for AHB in the checklist for this treatment. Risks and opportunities The application is not submitted because it was not initiated by the doctor, the process was not followed up by the social services, was lost in the administrative process or was not approved by the funding organisation. Checkpoints must therefore be included in the process, e.g. on discharge, by notifying the doctor providing further treatment in the medical report, enquiry on re-presentation Documentation Application form for AHB, also electronically Query moments with result Resources Social service Medical report Responsibility and qualification The social services department is responsible for submitting the application. The medical service initiates the application and provides the medical data. The social services, medical service and patient select a suitable clinic together. Notes and comments Applicable documents Literature Terms Attachments Follow-up rehabilitation form pack (AHB) 2.5 Aftercare - Previous 2.5.08 Transfer to another hospital Next - 2.5 Aftercare 2.5.10 Accommodation in an elderly care facility
