August 30, 2017
In Whatcom County, like other counties across the US, patients are leaving hospitals “quicker and sicker.” As many as 20 percent of patients experience medical complications within days of discharge that take them back to the hospital. Common post-discharge problems include adverse drug events, infections, worsening of chronic conditions, and inability to get help for basic needs.
To address 30 day post discharge Medicare readmissions, HMN has entered into an agreement with the Christian Health Care Center to pilot the CHCC Care Transitions Model successfully used for the past five years.
This will be a collaborative effort of the Care Transitions Team pictured here. Initially, eight FCNs will be accepted for this pilot program.
Over a six-week period, 1-2 FCNs at a time will receive an initial orientation to the CHCC and the Care Transitions Model.
FCNs who participate are encouraged to develop a Care Transitions model that works for them and their congregation. If we are successful, Care Transitions will become an established part of nursing practice in seven local congregations.
The CHCC Care Transitions pilot is funded by a grant from the PeaceHealth Community Fund.
For more information contact:
LeAna Osterman, RN, FCN