11 items found
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SMART Discharge Protocol
Current average rating is 4 stars.
The SMART Discharge Protocol (Signs, Medications, Appointments, Results, and Talk with me) was developed to improve care for patients and families and to improve the discharge process. The tools include the SMART Discharge Checklist for patients and families, FAQs for health care staff and clinicians about implementing the SMART Discharge Protocol, a presentation, and a self-learning packet.
Readmissions Diagnostic Worksheet
Current average rating is 4 stars.
This diagnostic tool helps hospitals perform an in-depth review of the last five rehospitalizations to identify opportunities for improvement.
How-to Guide: Improving Transitions from the Hospital to the Clinical Office Practice to Reduce Avoidable Rehospitalizations
Current average rating is 3 stars.
This How-to Guide is designed to support office practice-based teams and their community partners in codesigning and reliably implementing improved care processes to ensure that patients who have been discharged from the hospital have an ideal transition back to the care team in the office practice, with the related goal of reducing avoidable readmissions.
How-to Guide: Improving Transitions from the Hospital to Skilled Nursing Facilities to Reduce Avoidable Rehospitalizations
Current average rating is 5 stars.
This How-to Guide supports teams in skilled nursing facilities (SNFs) and their community partners in codesigning and reliably implementing improved care processes to ensure that residents have a safe and effective transition into the SNF, with the related goal of reducing avoidable readmissions into the hospital.
How-to Guide: Improving Transitions from the Hospital to Home Health Care to Reduce Avoidable Rehospitalizations
Current average rating is 5 stars.
This How-to Guide is designed to support home health care improvement teams and their hospital and community partners in creating an ideal reception into home health care in the first 48 hours after the patient is discharged from the hospital, a post-acute care setting, or a rehabilitation facility, with the related goal of reducing avoidable rehospitalizations.
How-to Guide: Improving Transitions from the Hospital to Community Settings to Reduce Avoidable Rehospitalizations
Current average rating is 5 stars.
This How-to Guide is designed to support hospital-based teams and their community partners in codesigning and reliably implementing improved care processes to ensure that patients who have been discharged from the hospital have an ideal transition to the next setting of care, with the related goal of reducing avoidable readmissions.
How-to Guide: Improved Care for Patients with Congestive Heart Failure — Rural Hospitals Supplement
Current average rating is 0 stars.
The goal of this How-to Guide, which has been tailored specifically for rural hospitals, is to significantly improve care and reduce readmissions for patients with congestive heart failure by reliably implementing the recommneded components of care.
How-to Guide: Improved Care for Patients with Congestive Heart Failure
Current average rating is 5 stars.
The goal of this How-to Guide is to significantly improve care and reduce readmissions for patients with congestive heart failure by reliably implementing the recommended components of care.
Heart Failure Zone Flyer
Current average rating is 4 stars.
This handout helps patients recognize and understand the symptoms of heart failure and how to respond.
Getting Started Guide: Improving Care for Patients with Heart Failure — Focus on Ambulatory Care
Current average rating is 0 stars.
This Guide builds on the promising work in the hospital setting by applying known best practices to the outpatient care of individuals with heart failure, and by highlighting the high-leverage opportunities for improvement in office practices.
Physician Admission Orders: Congestive Heart Failure
Current average rating is 0 stars.
This form is a good example of a admission order set used to indicate physician admission orders for patients with congestive heart failure. This order set supports good communication, teamwork, and reliable care processes that lead to safe care and good discharge processes.
  

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