Texoma Care Transition Coalition Meeting
Coalition Areas of Expertise
SNIFS, Physician Practices, ALF, Palliative Care Org’s, HH, Dialysis, Hospice, Palliative Care, Health Care Providers (Hospitals, ACO, LTAC, IRF), Health Care Providers (Hospitals, ACO, LTAC, IRF)
*Teleconference available – contact Judy Hunt (903)-813-3505 for additional info
- SNF Interview Guide The Interview Guide is for root cause and is directed for home health staffing questions to look at staff perception;
- JT Audit Tool JT Audit tool is for home health chart audits. You look at 5-10 readmit patient charts and look for trends as to why they returned;
- Hospice Care Methods Process Methods Process of Care Hospice is an algorithm for hospice audits to look at the hospice processes;
- ACH Clinical Record Review Tool ACH is a good home health tool for looking at processes;
- Survey in Patient Data Collection Survey in patient is a good tool to assess if a patient carried through on their discharge plans and to see if there was a problem;
- SNF Audit tool Audit Tool SNF is for SNF’s chart audits. You look at 5-10 readmit patient charts and look for trends as to why they returned;
- HH Interview Guide The Interview Guide is for SNF’s root cause and is directed for SNF’s staffing questions to look at staff perception;
- PA Chart Review Audit Tool PA Chart Review Audit Tool is geared more for hospitals. Choose which one works best.
Texoma Care Transition Coalition Mission
The mission of the Texoma Care Transition Coalition is to eliminate unnecessary hospital re-admissions of Medicare beneficiaries at our local hospitals by enabling safe and effective transitions of patients between all settings of care, and empowering patients and their families to manage their health.
Important Information & Discussion
To the left you’ll find the root cause analysis for you to download & review, and assess your particular facility. This is a very important “1st step” of this process. Please bring your findings to the meeting and be prepared to discuss areas of concern and possible solutions to problem areas. Remember, we are here on a mission, to reduce re-hospitalizations long term and to communicate and improve the exchange of core clinical information among providers, caregivers, families, patients and other authorized entities. The more involved you are, the quicker we can work as a successful community team to accomplish this goal.
We know simply raising broad awareness of better practice will not achieve sustainable results. It will not change behaviors on a large scale unless communities share, interact, ask, integrate and implement to create a forceful momentum for change!
Please RSVP by Contacting Judy Hunt via email at email@example.com.