Hospitals in pursuit of excellence

Targeted Education Reduces Readmissions

A “simple” complex plan is reducing readmissions at Wythe County Community Hospital, a 100-bed facility in Wytheville, Va. Care teams reviewed data to determine which patients kept returning to WCCH within 30 days of discharge—and frequently visiting the ED—and developed the “15 Families Initiative.” Before discharging identified patients, care providers meet with patient and family to discuss the patient’s condition, medical history and care plan. Family members learn how to help provide care, but working with patients one-on-one is key, says CEO Timothy Bess. After discharge, Barbara Patton, director of patient education, follows up by phone, tailoring information to each patient’s and family’s needs. Using the teach-back method, Patton advises on carb counting or glycemic control, for example. “We intercept with issues…and give patients the tools they need to control disease processes at home,” she says. The WCCH care team collaborates constantly, including with ED physician Tracy Mathena, a clinician champion for the initiative. CEO Bess observes, “Case managers play a huge role in making this program successful.” He adds, “Everyone has recognized the value that this program can bring to the lives of people in our community.” WCCH’s hospital-wide readmission rate was 6.8 percent in 2012 and down to 4.7 percent to date in 2013. 
For more information, contact Bess or Patton at.