VNA of Southwest Georgia, Inc.

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VNA of Southwest Georgia, Inc.

• Reducing the Acute Care Hospitalization Rate

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Step One Where Are We Now?

• What were the main reasons for admission?
• Who are the staff seeing the patient?
• What are the main diagnosis?

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Step Two Identify Problem Areas

• Highest Percentage of Patients admitted for
  Respiratory Issues
• Multiple Nurses Seeing Patient
• PT Only Patients with Medical Problems

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Step Three Educate Staff

• Goal Achieve Staff Buy In
• Inservices Held in Each Office
• Staff Given Chart Audit Tool and an ACH Chart
• One-on-One Training

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Step Four Plan of Action

• Phase 1 Identify Players
• Leadership Committee
• Field Staff
• Physical Therapy Staff
• Central Intake/ Scheduling Staff

• Phase 2-Formulate Plan
• Establish Care Pathways for Respiratory, CHF,
  Diabetes, Pressure ulcer, Falls
• Primary Nurse Concept
• Order for SN at Referral

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Step Five Implementation of Plan

• Form Multidisciplinary Care Pathways Team
• Medical Director Provide Inservice To Staff
• Assign Nurse Territories
• Establish Criteria for SN Referral at Intake

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Step Six Monitoring

• Monitor Monthly Acute Care Hospitalization Rate
• Utilization Review
• Monthly Review and Submission of Data to GMCF