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Care On-Going

Care On-Going . Learning Session IV December 16, 2011. Aim .

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Care On-Going

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  1. Care On-Going Learning Session IV December 16, 2011

  2. Aim • How we can establish safe and effective transitions of care from Regions Hospital to Westside and Open Cities community clinics, in order to, reduce all-cause, non-elective, 30-day readmission rates, of self-pay patients, by 5% by December 31, 2011.

  3. Progress • EBAN Open House @ Regions Hospital • More intentional about outreach • Directed approaches to reach out to community churches and other organizations • Increase community visibility

  4. Progress • RETURN TO SENDER LEAN TEAM • Multidisciplinary team that is addressing, consent, d/c summary completion and electronic record sharing in a timely manner, and collection of adequate PCP and clinic data for admitted patient

  5. Progress • Regions Hospital overall rate of readmission - 9.65% (lowest in 4 years). • To be determined- % of self-pay patients from this data

  6. Progress • Saint Paul Promise Neighborhood • Effort to ensure all children succeed in School by engaging residents to develop cradle-to-career support • 250 block area in the Summit-University and Frogtown neighborhoods, in St. Paul • HP Midway a part of Solution Action Group

  7. Learning Experiences • Having a repository of QI projects is necessary • EFFECTIVE and CONTINUAL communication can prevent duplication of work • Easy to form unintentional silos

  8. Questions

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