A group of frontline nurses from Covenant Health Plainview has changed the way patients are dismissed, lowering considerably the rate of readmissions to the hospital. The program has been so successful, one top administrator is traveling to Washington, D.C. this week to present the plan to her peers.
A fragmented health care system and lack of communication has left discharged patients confused about follow-up care, medications and financial resources leading to unnecessary hospital readmissions and deterioration of their disease processes. Hospitals around the country are actively seeking ways to reduce readmissions in order to not only avoid penalties, but improve patient care.
Excessive avoidable readmission rates have forced Medicare to implement the readmissions reduction program, due to a reported spending rate of $17.8 billion a year on readmissions that could have been avoided.
The Transition Care Team at Covenant Health Plainview recently developed a program to address the hospital’s readmission rate. Patients with conditions that often lead to hospital readmission were asked to be a part of the transition care program, at no charge. Upon discharge from the hospital, these patients were visited at home or care facility by their nursing team (the same nurses the patients see on the floor) for the sole purpose of education and encouraging follow-up with their physician. During these follow-ups, nurses educate further on the disease process, medications and resources available for their long-term health and recovery.
Covenant Health Plainview has seen such outstanding results with the plan, its chief nursing officer Leslie Hackett was selected by Premier, Inc. to present the program at this week’s annual Breakthroughs Conference in Washington, D.C. She will address the group Thursday (June 23).
“Our front line staff are passionate, highly-skilled, forward-thinkers and are excited to be on the forefront of patient care nationwide,” Hackett said. “This speaks volumes for the care that we provide here at Covenant Health Plainview.”
To learn more about this program and Covenant Health Plainview, please visit covenantplainview.org
(Press release from Covenant Health System)
