Wood County

Wood County
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This strategy focuses on reducing readmissions by improving transitions of care, identifying high-risk patients, and enhancing coordination among healthcare staff. By implementing a transitions coordinator and timely staffings, the goal is to significantly reduce the number of individuals with multiple readmissions. The impact includes better patient outcomes and increased capacity while keeping patients in the community.

  • Healthcare
  • Readmissions
  • Patient Care
  • Coordination
  • Strategy

Uploaded on Mar 01, 2025 | 0 Views


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  1. Wood County Return-to-Hospital Reduction

  2. AIM Big AIM: Reducing Readmissions Small AIM: Reduce the number of individuals who have been re-admitted more than 1 time (individuals with 2+ re-admissions) by 50% Baseline= 37% Goal= 18% Hiring a Transitions Coordinator Staffing Readmissions or High Risk Patients

  3. Changes Made Transitions Coordinator Identified Candidate, Starts 1/1/18 Bridgeway Utilization Staffings Completed within 72 hours of readmit Identify High Risk patients Inpatient SW, Head Nurse, DON, Psychiatrist, Administrator, Outpatient Administrator, Legal Services and other staff as needed

  4. By the numbers 2016: 317 discharges, 53 readmits, 16.7% 2017: 167 discharges, 10 readmits, 6.0% (thru 8/31) SFY2009 10.3% SFY2010 11.2% SFY2011 12.0% SFY2012 7.9% SFY2013 8.7% SFY2014 14.3% SFY2015 11.6% SFY2016 16.7% Wood Co HSD ALOS: 2016: 6.24 days 2017: 8.21 days Number of multiple readmits: 2016: 37% 2017: goal 18%, ytd 20%

  5. Adopt, Adapt, or Abandon? Adopted and Adapted Continue the staffings Implement Transitions Coordinator 2018 Psychiatrist change anticipated in 2018 Next Steps Continue to monitor ALOS and Readmits Continue staffings Survey Patients

  6. Impact Provided better care, continuity Increased our capacity and census Better patient outcomes, kept them in the community

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