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The Readmission Reduction "Get-Stuff-Done" Approach

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Tuesday, December 4, 2018

Covenant Medical Center in Lubbock, Texas, shares its readmission reduction "get-stuff-done" approach.

Covenant Medical Center has coined a "get-stuff-done" (GSD) approach which focuses attention to the standard transition-of-care components of employing the multidisciplinary team to facilitate best practices across the continuum of care—ensuring post-discharge medications are available, scheduling follow-up visits with the primary care physician, using the teach-back strategy, and supporting warm hand-offs. Success factors of the GSD approach include a day long retreat dedicated to creation of a focused strategy developed by multidisciplinary care givers from multiple facilities throughout the region and collaborating to facilitate provision of best care to patients throughout their community: One Community, One Goal. Monthly touch-base calls maintain focus on the strategic plan and promote success by facilitating removal of barriers by the regional executive team. To complement, the readmission reduction committee has been chartered regionally to focus on reduction of readmissions in high-risk populations. Detailed project plans/tactics are created in collaboration with their community partners. For example, mobile integrated health (paramedics), dialysis centers, nursing homes, skilled nursing facilities, the covenant health plan navigation team, and patient/family partnerships.

For additional readmission best practices by Covenant Medical Center, please read the June 2018 readmissions best practice story.  

For more information, please contact Cherrideth Orr, BSN, RN, CPHQ, Lead Quality Specialist for Covenant Medical Center, Covenant Health/Providence St. Joseph Health, at csorr@covhs.org.